| Objectives:Community-acquired pneumonia (CAP) is an infectious disease with high morbidity, which threatens human health. Early studies abroad had displayed that soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) was a highly specific and highly sensitive predictor to infectious diseases, but recently researches have shown that there is a great controversy of its value in disease diagnosis and differential diagnosis. The relationship between sTREM-1 and CAP has not been reported in domestic. This study investigated the value of sTREM-1 in diagnosis and the relationship between STREM-1 and the severity of CAP, by comparing the levels of inflammatory mediators [sTREM-1, TNF-a, IL-10 and high sensitivity C-reactive protein (Hs-CRP)]and dynamic monitoring changes of sTREM-1 in plasma and BALF of serious CAP patients, to provide theoretical basis for CAP clinical treatment. Methods:Thirty-four CAP patients whom were chosen based on the diagnostic standards of CAP in 2006, and thirty-four control subjects took part in this study. The CAP patients were separated into two groups twelve acquired serious CAP (seven are alive, five have been dead), twenty-two were not serious.Fourteen lung cancer patients without infection and twenty normal controls made up the control group. Plasma and BALF (by electronic bronchoscope) were collected in patients and control subjects. Severe pneumonia group were collected plasma and BALF on the first day, the third and the seventh day. We detected the level of sTREM-1, TNF-α, and IL-10 in BALF and plasma using enzyme linked immunosorbent assay (ELISA). The neutrophil count of peripheral blood in CAP patients were recorded. The plasma of all subjects were sent to the hospital laboratory to detect the Hs-CRP levels. All data was expressed by mean±standard deviation (X±S), and was statistically analyzed by using Statistical Product and Service Solutions 17.0 (SPSS 17.0). P<0.05 indicated a statistically significant difference.Results:The levels of sTREM-1 in plasma [(68.41±22.91) ng/L] and in BALF [(222.33±53.35)ng/L] of the CAP patients were much higher than those [(48.14±7.95),(180.29±22.19) ng/L] of the control group(P<0.01). The level of TNF-a in plasma [(89.53±10.35) ng/L] of the CAP patients was higher than that [(82.37±12.36) ng/L] of the control group(P<0.05). The level of Hs-CRP in plasma [(7.76±5.41) mg/L] of the CAP patients was much higher than that [(3.12±2.11) mg/L] of the control group (P<0.01).The levels of sTREM-1 in plasma [(75.73±28.23) ng/L] of the severe pneumonia patients and [(64.42±18.96) ng/L] of the ordinary pneumonia patients were higher than those[(43.12±5.52) ng/L]of the normal control group (P<0.05). The level of sTREM-1 in the BALF [(75.73±28.23) ng/L] of the severe pneumonia patients was higher than that of the lighter pneumonia patients [(207.40±51.60) ng/L, The lung cancer patients without infection group [(185.38±16.90) ng/ L and the normal control group[(176.73±25.05) ng/L (P<0.01).That of the lighter pneumonia patients group was higher than the normal control group (P<0.05). The levels of TNF-αin plasma of the severe pneumonia were higher than the ordinary pneumonia group and the normal control group (P <0.01).There was no difference between the severe pneumonia group and the lung cancer patients without infection group (P> 0.05).The level of TNF-a in BALF of the severe pneumonia was higher than the lighter pneumonia group and the normal control group (P<0.01). The level of IL-10 in plasma of the severe pneumonia group was higher than the ordinary pneumonia group and the normal control group (P<0.05). The levels of IL-10 in BALF of the severe pneumonia group and the lung cancer patients without infection group were higher than the normal control group (P<0.05). There was no difference between the severe pneumonia group and the Lung cancer patients without infection group (P> 0.05). The level of Hs-CRP in plasma of the severe pneumonia was higher than the ordinary pneumonia group and the lung cancer patients without infection group and the normal control group (P<0.01). The levels of sTREM-1 in plasma and BALF of survival group in severe pneumonia group showed a trend to decrease:the sTREM-1 levels in survival group's plasma were (76.59±27.89) ng/L on the first day, (70.68±36.28) ng/L on the third day, respectively and (44.75±4.04) ng/L on the seventh day. The sTREM-1 levels in survival group's BALF were (239.24±24.78) ng/L on the first day, (231.06±52.01) ng/L on the third day, and (178.8±19.39) ng/L on the seventh day. The sTREM-1 levels in survival group's plasma and BALF of the seventh day were lower than the first day and the third day (P<0.05).The levels of sTREM-1 in plasma and BALF of the death group in severe pneumonia group increased to the highest level on the seventh day. The sTREM-1 levels in the death's plasma were (117.69±32.93) ng/L on the seventh day, higher than that [(342.80±50.71) ng/L] on the first day(P<0.05). The sTREM-1 levels in the death's BALF were (271.15±62.33) ng/L on the first day, (342.80±50.71) ng/L on the 3rd day and (419.73±52.26) ng/L on the seventh day. The level of the seventh day was higher than the 1st day(P<0.01) and the 3rd day (P<0.05). The areas under the ROC curve of sTREM-1 in BALF and plasma were 0.838 (95% CI:0.72-0.95) and 0.789(95% CI:0.66-0.92), greater than the other inflammatory markers of this study. The level of sTREM-1 in plasma of CAP was correlated positively to the number of neutrophils in blood(r=0.818, P<0.01). Conclusions:STREM-1, TNF-a and IL-10 were associated with the pathogenesis of CAP. The levels of sTREM-1 in BALF have great reference value for distinguishing infectious diseases from non-infectious. The level of sTREM-1 in BALF> 211.88ng/L as the standard, the sensitivity of diagnosis of pneumonia was 70%, specificity was 91%. The sTREM-1 levels in the BALF and plasma are relative to the severity of pneumonia. The neutrophils maybe is the main source of TREM-1 CAP patients.
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