Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Prognostic Utility of the Soluble Triggering Receptor Expressed on Myeloid Cells-1 in Patients with Acute Respiratory Distress Syndrome

급성호흡곤란증후군 환자에서 Soluble Triggering Receptor Expressed on Myeloid Cells-1의 예후인자로서의 유용성

  • Huh, Jin Won (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Jung, Hoon (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Lim, Chae-Man (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Koh, Younsuck (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Sang-Bum (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 허진원 (인제대학교 의과대학 일산백병원 내과) ;
  • 정훈 (인제대학교 의과대학 일산백병원 내과) ;
  • 임채만 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 고윤석 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 홍상범 (울산대학교 의과대학 서울아산병원 호흡기내과)
  • Received : 2008.08.29
  • Accepted : 2008.10.01
  • Published : 2008.10.30
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Abstract

Background: The triggering receptor expressed on myeloid cells-1 (TREM-1) is an activating receptor that is expressed on the surface of neutrophils and mature monocytes when stimulated with several microbial components, which can amplify the inflammatory response. This study analyzed the prognostic value of the sTREM-1 levels in patients with acute respiratory distress syndrome (ARDS). Methods: The bronchoalveolar lavage (BAL) fluid and blood was collected prospectively from 32 patients with ARDS, 15 survivors and 17 nonsurvivors. An enzyme-linked immunosorbent assay was performed to measure the sTREM-1. The following data was obtained: APACHE II score, Clinical Pulmonary Infection Score (CPIS), BAL fluid analysis, C-reative protein. Mortality in the ICU was defined as the end point. Results: The serum sTREM-1 level was significantly higher in the nonsurvivors than survivors ($54.3{\pm}10.3pg/ml$ vs. $22.7{\pm}2.3pg/ml$, p<0.05). The sTREM-1 level in the serum, but not in the BAL fluid, was an independent predictor of the ICU mortality (OR: 22.051, 95% CI: 1.780~273.148, p<0.016), and a cut-off value of ${\geq}33pg/ml$ yielded a diagnostic sensitivity of 71% and specificity of 93%. Conclusion: The serum sTREM-1 level may be a useful predictor of the outcome of ARDS patients.

연구배경: Triggering receptor expressed on myeloid cells-1 (TREM-1)은 호중구와 단핵구의 표면에 표현되는 수용체로 호중구가 자극되면 표면에서 떨어져 수용체인 sTREM-1으로 존재하며 염증반응을 증폭시킨다. 본 연구는 호중구의 활성화가 중요한 병인인 급성호흡곤란증후군 환자의 기관지폐포세척액과 혈청에서 측정한 sTREM-1의 농도가 예후인자로서 유용성이 있는지 확인하고자 시행되었다. 방 법: 32명의 급성호흡곤란증후군 환자가 포함되었고 이 중 15명이 생존군, 17명이 사망군으로 분류되었다. 중증도 지표로 APACHE II score, Clinical Pulmonary Infection Score (CPIS)를 측정하였고, 기관지폐포세척액과 혈청에서 sTREM-1 농도를 측정하였고 중환자실 사망여부를 확인하였다. 결 과: 진단 시 급성호흡곤란증후군 환자의 혈청 내 sTREM-1의 농도는 사망군에서 생존군 보다 유의하게 상승되어 있었으나 ($54.3{\pm}10.3pg/ml$ vs. $22.7{\pm}2.3pg/ml$, p<.05) 기관지폐포세척액 내의 sTREM-1의 농도는 차이가 없었다. 혈청 내 sTREM-1의 농도는 급성호흡곤란증후군 환자의 예후를 예측할 수 있는 독립적인 인자(OR: 22.051, 95% CI: 1.780~273.146, p=0.016)이었고, 33pg/ml 경계로 분류 시 중환자실 사망률을 예측하는데 71%의 민감도와 93%의 특이도를 보였다. 결 론: 급성호흡곤란증후군 환자의 진단 당시 측정한 혈청 sTREM-1의 농도는 중요한 예후 인자로서 유용성이 있을 것으로 생각된다.

Keywords

References

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