降钙素原在感染性疾病诊断和监测中的应用

doi:10.3969/j.issn.1673-8640.2017.03.018

摘要/Abstract

摘要：

C反应蛋白（CRP）、白细胞计数、红细胞沉降率以及临床体征和症状是传统诊断炎症的指标,但这些指标对指导临床的鉴别诊断和用药缺乏敏感性和特异性。降钙素原（PCT）是大量病原菌入侵组织器官后,由细菌的内毒素或机体释放的炎症因子诱导相应的组织细胞而合成的。大量的临床研究数据支持将PCT作为感染性疾病诊断标志物的观点,其有助于感染源的控制以及指导抗菌药物的使用。文章对PCT在不同感染性疾病中的临床应用进行了综述。

关键词: 降钙素原, 感染, 脓毒症, 全身炎症反应综合征, 抗菌药物用药管理

Abstract:

Traditional biomarkers,including C-reactive protein（CRP）,leukocyte,erythrocyte sedimentation rate,clinical signs and symptoms,are not sufficiently sensitive or specific enough to guide treatment decisions in infectious diseases. Procalcitonin （PCT） is synthesized by tissues and organs in response to endotoxin or to mediators released,owing to a large number of pathogenic bacterial infection invasion. A growing body of evidence supports the use of PCT as a biomarker to improve the diagnosis of infectious diseases. The monitoring of PCT may contribute to the source control for infections and antibiotic therapy. The review summarizes the clinical application of PCT in different infection diseases.

Key words: Procalcitonin, Infection, Sepsis, Systemic inflammatory response syndrome, Antibiotic guidance

中图分类号:

R446.62

胡尧. 降钙素原在感染性疾病诊断和监测中的应用[J]. 检验医学, 2017, 32(3): 234-239.

HU Yao. Procalcitonin for the diagnosis and monitoring of infectious diseases[J]. Laboratory Medicine, 2017, 32(3): 234-239.

图/表 3

参考文献 48

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参考文献	感染标志物	特异性（%）	敏感性（%）	阈值
急诊疑似脓毒症患者PCT、CRP和IL-6水平与感染或败血症的相关性^[21]	PCT	感染：63~97	感染：68~18	0.1~3.0 ng/mL
急诊疑似脓毒症患者PCT、CRP和IL-6水平与感染或败血症的相关性^[21]	PCT	败血症：38~90	败血症：91~47	0.1~3.0 ng/mL
	IL-6	感染：67~96	感染：58~14	40~500 pg/mL
	IL-6	败血症：34~89	败血症：90~27	40~500 pg/mL
	CRP	感染：33~88	感染：90~43	40~100 mg/dL
	CRP	败血症：39~88	败血症：82~31	40~100 mg/dL
78例重症疑似感染和SIRS患者PCT和IL-6水平与脓毒症的相关性^[13]	PCT	78	97	1.1 ng/mL
78例重症疑似感染和SIRS患者PCT和IL-6水平与脓毒症的相关性^[13]	IL-6	72	67	200 pg/mL
急诊及感染科诊治161例社区获得性感染患者的队列研究^[22]	PCT	58	80	0.28 ng/mL
急诊及感染科诊治161例社区获得性感染患者的队列研究^[22]	白细胞计数	74	64	8.5×10⁹/L

参考文献	感染标志物	特异性（%）	敏感性（%）	阈值
急诊疑似脓毒症患者PCT、CRP和IL-6水平与感染或败血症的相关性^[21]	PCT	感染：63~97	感染：68~18	0.1~3.0 ng/mL
急诊疑似脓毒症患者PCT、CRP和IL-6水平与感染或败血症的相关性^[21]	PCT	败血症：38~90	败血症：91~47	0.1~3.0 ng/mL
	IL-6	感染：67~96	感染：58~14	40~500 pg/mL
	IL-6	败血症：34~89	败血症：90~27	40~500 pg/mL
	CRP	感染：33~88	感染：90~43	40~100 mg/dL
	CRP	败血症：39~88	败血症：82~31	40~100 mg/dL
78例重症疑似感染和SIRS患者PCT和IL-6水平与脓毒症的相关性^[13]	PCT	78	97	1.1 ng/mL
78例重症疑似感染和SIRS患者PCT和IL-6水平与脓毒症的相关性^[13]	IL-6	72	67	200 pg/mL
急诊及感染科诊治161例社区获得性感染患者的队列研究^[22]	PCT	58	80	0.28 ng/mL
急诊及感染科诊治161例社区获得性感染患者的队列研究^[22]	白细胞计数	74	64	8.5×10⁹/L

参考文献	特异性（%）	敏感性（%）	阈值（ng/mL）	临床相关性
住院患者（46例新生儿、638例儿童和702例成年人）PCT和CRP对诊断细菌感染准确性的研究^[26]	83	85	0.5~6.1	PCT诊断准确性优于 CRP
PCT对2 008例急诊患者菌血症诊断准确性的研究^[27]	70	76	0.4~0.5	PCT对急诊菌血症诊断性能一般
PCT对3 943例危重成人患者、外伤或手术患者诊断脓毒症、严重脓毒症或感染性休克准确性的研究^[28]	48~100	100~42	0.6~5.0	PCT是良好的生物学诊断标志物且优于CRP
PCT作为重症急性胰腺炎及感染坏死性胰腺炎诊断标志物的研究^[29]	重症急性胰腺炎：86 感染坏死性胰腺炎：91	重症急性胰腺炎：72 感染坏死性胰腺炎：80	>0.5	PCT可预测急性胰腺炎的严重程度和预估发生感染性胰腺坏死的风险
PCT对1 959例新生儿的脓毒症诊断准确性的研究^[30]	79	81	> 0.25	PCT对新生儿脓毒症的诊断具有良好的准确性

参考文献	特异性（%）	敏感性（%）	阈值（ng/mL）	临床相关性
住院患者（46例新生儿、638例儿童和702例成年人）PCT和CRP对诊断细菌感染准确性的研究^[26]	83	85	0.5~6.1	PCT诊断准确性优于 CRP
PCT对2 008例急诊患者菌血症诊断准确性的研究^[27]	70	76	0.4~0.5	PCT对急诊菌血症诊断性能一般
PCT对3 943例危重成人患者、外伤或手术患者诊断脓毒症、严重脓毒症或感染性休克准确性的研究^[28]	48~100	100~42	0.6~5.0	PCT是良好的生物学诊断标志物且优于CRP
PCT作为重症急性胰腺炎及感染坏死性胰腺炎诊断标志物的研究^[29]	重症急性胰腺炎：86 感染坏死性胰腺炎：91	重症急性胰腺炎：72 感染坏死性胰腺炎：80	>0.5	PCT可预测急性胰腺炎的严重程度和预估发生感染性胰腺坏死的风险
PCT对1 959例新生儿的脓毒症诊断准确性的研究^[30]	79	81	> 0.25	PCT对新生儿脓毒症的诊断具有良好的准确性

PCT阈值（ng/mL）	临床诊断	抗菌药物管理
< 0.1	非细菌性感染	不使用抗菌药物,6~24 h内复测PCT水平,根据临床症状与复检结果再进行评估
0.1~0.25	细菌性感染可能性小	不使用抗菌药物,但出现下列情况时,考虑使用抗菌药物：（1）生命体征异常;（2）需要重症监护;（3）肺气肿;（4）细菌培养阳性
> 0.25~0.5	可能细菌感染	使用抗菌药物,并于用药后第3、5、7天复查PCT
> 0.5	细菌感染可能性大	使用抗菌药物,治疗第3、5、7天复查PCT,若PCT水平下降80%~90%, 则考虑停止使用抗菌药物;若PCT水平持续升高,则表明治疗失败