흉수의 감별 진단 시 Soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1)의 유용성
Soluble Triggering Receptor Expressed on Myeloid cells-1: Role in the Diagnosis of Pleural Effusions
박은영 (분당차병원)
김원희 (분당차병원)
박웅 (분당차병원)
정혜철 (분당차병원)
이지현 (분당차병원)
김은경 (분당차병원)
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초록
연구 배경: 흉수는 다양한 원인에 의하여 생성되며 임상적으로 여출액과 삼출액으로 구분하게 되며 삼출액일 경우에는 그 원인 질환들을 감별해야 하나 적용할 만한 표지자가 많지 않다. Soluble Triggering Receptor Expressed on Myeloid cells(sTREM-1)는 면역글로블린의 일종으로 세균이나 진균 감염에서 증가된다고 보고되어 있으며 활성화된 탐식세포에서 떨어져 나와 체액에서도 수용성 상태로 발견될 수 있다. 저자들은 흉수에서 sTREM-1의 측정이 흉수의 감별 진단에 유용한지와 감염성 질환에 의한 흉수에 대한 표지자로서 유용한지에 대한 가능성을 알아보고자 하였다. 대상 및 방법: 2004년 3월부터 2005년 12월까지 흉수를 주소로 내원한 환자들에서 흉수의 세포 수 및 백혈구 분획, 생화학적 검사(pH, protein, LDH, glucose), 세포진 검사, ADA, 미생물학적 검사 결과 이외에 sTREM-1을 측정하였다. 대상환자는 48명으로 남:여 각각 27:21명이었고, 평균 연령은 59세였다. 최종 진단은 암성 흉수는 13명, 결핵성 흉수는 14명, 부폐렴성 흉수는 17명, 여출성 흉수는 4명이었다. 결 과: 흉수의 sTREM-1은 부폐렴성 흉수에서 344.0 ±488.7 pg/mL로 결핵성 흉수(81.7±56.6 pg/mL)와 악성 흉수(39.3±19.6 pg/mL)보다 높게 측정되었다. 부폐렴성 흉수에 대한 sTREM-1의 ROC 곡선 결과 55.4 pg/mL에서 민감도와 특이도가 각각 70.6%와 74.1%로 측정되었다. 또한 흉수 sTREM-1은 흉수의 호중구수, 흉수 LDH, 흉수/혈청 LDH, 흉수 ADA와 유의한 상관관계를 보였다.
- keywords
- Triggering receptor expressed on myeloid cells, Pleural effusion, Differential diagnosis., Triggering receptor expressed on myeloid cells, Pleural effusion, Differential diagnosis.
Abstract
Background: The currently available diagnostic markers for pleural effusion have a limited role. The soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) is a molecule recently reported to play an important role in the myeloid cell mediated inflammatory response, and is up regulated in the body fluid by bacterial or fungal products. This study examined the expression of sTREM-1 in pleural effusion. Methods: Between April 2004 and December 2005, 48 patients with pleural effusions were enrolled in this study. The pleural fluids were taken and analyzed for the total protein, glucose, lactate dehydrogenase (LDH), adenosine deaminase (ADA), and sTREM-1. Bacterial cultures and cytology tests were also performed. Results: The clinical diagnoses were 17 parapneumonic, 14 tuberculous, and 13 malignant effusions. Four patients presented with transudates. The mean ages of the parapneumonic, tuberculous and malignant effusion groups were 57.1±19.7, 49.5±18.6, 66.9±15.5, and 76.0±18.1. respectively. The level of sTREM-1 expression was significantly higher in the parapneumonic effusions (344.0±488.7) than in the tuberculous effusions (81.7±56.6) and malignant effusions (39.3±19.6). With a cut-off value of 55.4pg/ml, the sensitivity and specificity for a parapneumonic effusion was 70.6% and 74.1%. Conclusion: sTREM-1 expression is significantly higher in parapneumonic effusions, suggesting its potential role as an additional diagnostic marker for pleural effusions. (Tuberc Respir Dis 2007; 62: 290-298)
- keywords
- Triggering receptor expressed on myeloid cells, Pleural effusion, Differential diagnosis., Triggering receptor expressed on myeloid cells, Pleural effusion, Differential diagnosis.
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