慢性阻塞性肺疾病急性加重患者血清sTREM-1水平及其临床诊断价值研究

目的 探讨慢性阻塞性肺疾病急性加重（acute exacerbation of chronic obstructive pulmonary disease，AECOPD）患者的血清可溶性髓细胞触发受体-1（souble triggering receptor expressed on myeloid cells-1，sTREM-1）水平及其诊断AECOPD的临床价值。方法 纳入2012年2月~2015年10月就诊的AECOPD患者70例，同时纳入稳定COPD患者44例（稳定COPD组）及健康人33例（健康对照组）作为对照。首次就诊时记录患者一般情况并检测呼吸功能，同时检测外周血sTREM-1水平、C反应蛋白（c-reactive protein，CRP）及降钙素原（procalcitonin，PCT）水平。结果 AECOPD组sTREM-1水平显著高于sCOPD组及健康对照组，差异有统计学意义（P<0.05）。AECOPD组患者治疗前sTREM-1水平显著高于治疗后，差异有统计学意义（P<0.05）。AECOPD组患者血清sTREM-1与CRP（r=0.674，P=0.000）、PCT（r=0.616，P=0.000）、WBC（r=0.648，P=0.000）及呼吸功能GOLD分级（r=0.454，P=0.000）呈显著正相关；sTREM-1水平与PO₂（r=-0.363，P=0.002）、FEV1%（r=-0.489，P=0.000）呈显著负相关。血清sTREM-1单独诊断AECOPD的AUC为0.793（95% CI：0.717~0.868），sTREM-1联合CRP及PCT诊断AECOPD的AUC为0.830（95% CI：0.762~0.898）。结论 AECOPD患者血清Strem-1水平可出现显著增高，且与呼吸功能损害严重程度相关。STREM-1可作为AECOPD诊断的候选指标，且联合CRP及PCT可进一步改进诊断效能。

Serum sTREM-1 Level in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Its Clinical Diagnostic Value

Objective To investigate the serum souble triggering receptor expressed on myeloid cells-1 (sTREM-1) level in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and its clinical value. Methods A total of 70 patients with AECOPD from February 2012 to October 2015 were enrolled, and 44 patients with stable COPD (stable COPD group) and 33 healthy people (control group) were enrolled as control. General situations and pulmonary function were recorded. The sTREM-1, C-reactive protein (CRP) and procalcitonin (PCT) levels were detected. Results The sTREM-1 level in AECOPD group was significantly higher than sCOPD group and control group. sTREM-1 level in pre-treatment patients was significantly higher than pro-treatment. In AECOPD group, sTREM-1 was significantly positively associated with CRP (r=0.674, P=0.000), PCT (r=0.616, P=0.000), WBC (r=0.648, P=0.000) and GOLD grade (r=0.454, P=0.000), and was negatively associated with PO₂ (r=-0.363, P=0.002), FEV1% (r=-0.489, P=0.000). AUC of sTREM-1 for AECOPD diagnosis was 0.793 (95%CI:0.717-0.868), and AUC of sTREM-1 combined with CRP and PCT was 0.830 (95%CI:0.762-0.898). Conclusion There is an elevated serum sTREM-1 level in AECOPD patients, which is associated with severity of respiratory function. The sTREM-1 is a candidate for AECOPD diagnosis, which could be improved by combining with CRP and PCT.