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中华肺部疾病杂志(电子版) ›› 2024, Vol. 17 ›› Issue (04) : 663 -666. doi: 10.3877/cma.j.issn.1674-6902.2024.04.034

综述

降钙素原在脓毒血症与肺部感染中的研究进展
甘志新1, 胡雍军2, 肖晶2, 胡明冬3,()   
  1. 1. 830000 乌鲁木齐,新疆军区总医院心血管内科
    2. 844200 喀什,中国人民解放军第947医院心肾内科
    3. 400038 重庆,陆军(第三)军医大学第二附属医院老年与特勤医学科
  • 收稿日期:2024-01-08 出版日期:2024-08-25
  • 通信作者: 胡明冬

Application of procalcitonin in sepsis

Zhixin Gan, Yongjun Hu, Jing Xiao   

  • Received:2024-01-08 Published:2024-08-25
引用本文:

甘志新, 胡雍军, 肖晶, 胡明冬. 降钙素原在脓毒血症与肺部感染中的研究进展[J]. 中华肺部疾病杂志(电子版), 2024, 17(04): 663-666.

Zhixin Gan, Yongjun Hu, Jing Xiao. Application of procalcitonin in sepsis[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(04): 663-666.

脓毒血症(sepsis)是由于机体特别是肺感染的不协调反应引起的一种危及生命的器官脏器功能障碍,重症监护病房最常见的危重症,其因高发生率及病死率备受关注[1]。早诊断、早治疗可以减少病死率。目前关于脓毒血症在临床上主要面临着早期诊断缺乏快速准确生物标志物、治疗时抗生素使用与停止时机难把控、预后指标指示性较差等主要问题。降钙素原(procalcitonin, PCT)的出现解决了这些的困难。生理情况下PCT主要由甲状腺的C-细胞合成,在肝、脾、肺、肾等器官也有少量分泌,并在PCT进入全身循环之前转化为降钙素。PCT作为传统的炎症标记物,应用在脓毒血症的诊断中准确有效,经济简便,同时在指导抗生素的使用及评估预后等方面也有重要作用。目前脓毒血症的指南共识中PCT是唯一推荐在脓毒血症中大量使用的生物标志物。引起脓毒血症的病原学微生物主要包括细菌、病毒、真菌等,其中以细菌性感染为主,由于不能准确识别感染源,无法准确选用合适的抗生素类型[2]。Le Moullec等1984年首次提出PCT是降钙素116个氨基酸残基,正常情况下由甲状腺合成并释放进入血液,在正常人群血清及病毒感染层面处于较低水平(<0.05 ng/ml),脓毒血症患者由于感染较为严重,PCT水平较高;对脓毒症患者进行抗菌治疗后,PCT的水平会明显下降,提示PCT在脓毒血症患者中具有重要作用。本文对PCT在细菌性脓毒血症的诊断、治疗及预后等方面的进展进行综述[3,4]

1
Bracht H, Hafner S, Weiss M. Sepsis update: Definition and epidemiology[J]. Anasthesiol Intensivmed Notfallmed Schmerzther, 2019, 54(1): 10-20.
2
Jee Y, Carlson J, Rafai E, et al. Antimicrobial resistance: A threat to global health[J]. Lancet Infect Dis, 2018, 18(9): 939-940.
3
Sager R, Kutz A, Mueller B, et al. Procalcitonin-guided diagnosis and antibiotic stewardship revisited[J]. BMC Med, 2017, 15(1): 15.
4
Bouadma L, Luyt CE, Tubach F, et al. Use of procalcitonin to reduce patients′exposure to antibiotics in intensive care units (PRORATA trial): A multicentre randomised controlled trial[J]. Lancet, 2010, 375(9713): 463-474.
5
Song X, Song Y, Zhang X, et al. Soluble triggering receptor expressed on myeloid cells-1 as a novel marker for abdominal sepsis[J]. Surg Infect (Larchmt), 2017, 18(5): 577-581.
6
Hamed S, Behnes M, Pauly D, et al. Diagnostic value of Pentraxin-3 in patients with sepsis and septic shock in accordance with latest sepsis-3 definitions[J]. BMC Infect Dis, 2017, 17(1): 554.
7
Yoon SH, Kim EH, Kim HY, et al. Presepsin as a diagnostic marker of sepsis in children and adolescents: a systemic review and meta-analysis[J]. BMC Infect Dis, 2019, 19(1): 760.
8
Tan M, Lu Y, Jiang H, et al. The diagnostic accuracy of procalcitonin and C-reactive protein for sepsis: A systematic review and meta-analysis[J]. J Cell Biochem, 2019, 120(4): 5852-5859.
9
Gbinigie OA, Onakpoya IJ, Richards GC, et al. Biomarkers for diagnosing serious bacterial infections in older outpatients: a systematic review[J]. BMC Geriatr, 2019, 19(1): 190.
10
Schuetz P, Beishuizen A, Broyles M, et al. Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use[J]. Clin Chem Lab Med, 2019, 57(9): 1308-1318.
11
Tang JH, Gao DP, Zou PF, et al. Comparison of serum PCT and CRP levels in patients infected by different pathogenic microorganisms: a systematic review and meta-analysis[J]. Braz J Med Biol Res, 2018, 51(7): e6783.
12
Wiwatcharagoses K, Kingnakom A. Procalcitonin under investigation as a means of detecting severe sepsis, septic shock and bacteremia at emergency department, rajavithi hospital[J]. J Med Assoc Thai, 2016, 99(Suppl 2): S63-S68.
13
Mathew B, Roy DD, Kumar TV. The use of procalcitonin as a marker of sepsis in children[J]. J Clin Diagn Res, 2013, 7(2): 305-307.
14
Nargis W, Ibrahim MD, Ahamed BU. Procalcitonin versus C-reactive protein: usefulness as biomarker of sepsis in ICU patient[J]. Int J Crit Illn Inj Sci, 2014, 4: 195-199.
15
Yang AP, Liu J, Yue LH, et al. Neutrophil CD64 combined with PCT, CRP and WBC improves the sensitivity for the early diagnosis of neonatal sepsis[J]. Clin Chem Lab Med, 2016, 54(2): 345-351.
16
Barrier KM. Summary of the 2016 international surviving sepsis campaign:a clinician′s guide[J]. Crit Care Nurs Clin North Am, 2018, 30(3): 311-321.
17
Bouadma L, Luyt CE, Tubach F, et al. Use of procalcitonin to reduce patients′exposure to antibiotics in intensive care units (PRORATA trial): A multicentre randomised controlled trial[J]. Lancet, 2010, 375(9713): 463-474.
18
de Jong E, van Oers JA, Beishuizen A, et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: A randomised, controlled, open-label trial[J]. Lancet Infect Dis, 2016, 16(7): 819-827.
19
Wirz Y, Branche A, Wolff M, et al. Management of respiratory infections with use of procalcitonin: Moving toward more personalized antibiotic treatment decisions[J]. ACS Infect Dis, 2017, 3(12): 875-879.
20
Pepper DJ, Sun J, Rhee C, et al. Procalcitonin-guided antibiotic discontinuation and mortality in critically Ill adults: A Systematic Review and Meta-analysis[J]. Chest, 2019, 155(6): 1109-1118.
21
降钙素原急诊临床应用专家共识组. 降钙素原(PCT)急诊临床应用的专家共识[J]. 中华急诊医学杂志2012, 21(9): 944-951.
22
Jensen JU, Hein L, Lundgren B, et al. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: A randomized trial[J]. Crit Care Med, 2011, 39(9): 2048-2058.
23
Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America[J]. Clin Infect Dis, 2016, 62: e51-e77.
24
Braha B, Mahmutaj D, Maxhuni M. Correlation of procalcitonin and C-reactive protein with intra-abdominal hypertension in intra-abdominal infections: their predictive role in the progress of the disease[J]. Open Access Maced J Med Sci, 2018, 6(3): ?479-484.
25
Zhou G, Ho KM. Procalcitonin concentrations as a predictor of unexpected readmission and mortality after intensive care unit discharge: A retrospective cohort study[J]. J Crit Care, 2016, 33: 240-244.
26
Sager R, Kutz A, Mueller B, et al. Procalcitonin-guided diagnosis and antibiotic stewardship revisited[J]. BMC Med, 2017, 15(1): 15.
27
Yavuzer H, Cengiz M, Yavuzer S, et al. Procalcitonin and pentraxin-3:current biomarkers in inflammation in white coat hypertension[J]. J Hum Hypertens, 2016, 30(7): 424-429.
28
Hernán T, Mariana D, Alexis M, et al. Pro-calcitonin and inflammation in chronic hemodialysis[J]. Medicina (B Aires), 2013, 73(5): 411-416.
29
Bajpai D, Pednekar S, Pandey D, et al. Association of plasma procalcitonin with various components of metabolic syndrome and insulin resistance in Urban Indian Population: A novel biomarker[J]. J Assoc Physicians India, 2018, 66(12): 35-38.
30
Wang WJ, Zhang XM, Ge N, et al. Procalcitonin testing for diagnosis and short-term prognosis in bacterial infection complicated by congestive heart failure: a multicenter analysis of 4,698 cases[J]. Crit Care, 2014, 18(1): R4.
31
Ko YH, Ji YS, Park SY, et al. Procalcitonin determined at emergency department as na early indicator of progression to septic shock in patient with sepsis associated with ureteral calculi[J]. Int Braz J Urol, 2016, 42(2): 270-276.
32
Wang X, Sun Y, Shao X. Predictive value of procalcitonin for infection of patients with type-2 diabetes mellitus[J]. Exp Ther Med, 2019, 18(1): 722-728.
33
胡雍军,张俊鸿,熊 玮. 脓毒症患者血清降钙素原水平的影响因素分析[J]. 第三军医大学学报2020, 42(22): 2219-2223.
34
胡雍军,郜 攀,章陈晨. 血清降钙素原联合呼吸频率检查对脓毒性休克预测的研究[J]. 重庆医学2021, 50(21): 3639-3642, 3646.
35
De Kraker ME, Stewardson AJ, Harbarth S. Will 10 million people die a year due to antimicrobial resistance by 2050?[J]. PLOS Med, 2016, 13(11): e1002184.
36
De Waele JJ, Boelens J, Leroux-Roels I. Multidrug-resistant bacteria in ICU: fact or myth[J]. Curr Opin Anaesthesiol, 2020, 33(2): 156-161.
37
Vincent JL, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units[J]. JAMA, 2009, 302(21): 2323-2329.
38
Klein KP, Cremer OL, van Vught LA, et al. Likelihood of infection in patients with presumed sepsis at the time of intensive care unit admission: a cohort study[J]. Crit Care, 2015, 19(1): 319.
39
Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021[J]. Intensive Care Med, 2021, 47(11): 1181-1247.
40
Reinhart K, Meisner M. Biomarkers in the critically ill patient: procalcitonin[J]. Crit Care Clin, 2011, 27(2): 253-263.
41
Schwarz S, Bertram M, Schwab S. Serum procalcitonin levels in bacterial and abacterial meningitis[J]. Crit Care Med, 2000, 28(6): 1828-1832.
42
Pfister R, Kochanek M, Leygeber T, et al. Procalcitonin for diagnosis of bacterial pneumonia in critically ill patients during 2009 H1N1 influenza pandemic: a prospective cohort study, systematic review and individual patient data meta-analysis[J]. Crit Care, 2014, 18(2): R44.
43
Schuetz P, Wirz Y, Sager R, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections[J]. Cochrane Database Syst Rev, 2017, 10(10): D7498.
44
Bouadma L, Luyt CE, Tubach F, et al. Use of procalcitonin to reduce patients′exposure to antibiotics in intensive care units (PRORATA trial): A multicentre randomised controlled trial[J]. Lancet, 2010, 375(9713): 463-474.
45
Papp M, Kiss N, Baka M, et al. Procalcitonin-guided antibiotic therapy may shorten length of treatment and may improve survival-a systematic review and meta-analysis[J]. Crit Care, 2023, 27(1): 394.
46
Paudel R, Dogra P, Montgomery-Yates AA, et al. Procalcitonin: A promising tool or just another overhyped test? [J]. Int J Med Sci, 2020, 17(3): 332-337.
47
Mierzchala-Pasierb M, Lipinska-Gediga M. Sepsis diagnosis and monitoring-procalcitonin as standard, but what next?[J]. Anaesthesiol Intensive Ther, 2019, 51(4): 299-305.
48
马 兰,胡迎春,张 川,等. 脓毒症关键基因的筛选与生物信息学分析[J]. 西南医科大学学报2022, 45(3): 206-210.
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