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中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (02) : 341 -345. doi: 10.3877/cma.j.issn.1674-6902.2026.02.026

综述

血清降钙素原在社区获得性肺炎严重程度评估及抗生素使用指导中的临床应用研究进展
陈力, 高心怡, 刘心怡, 邵幼林()   
  1. 213002 江苏,南京医科大学常州医学中心感染性疾病科
  • 收稿日期:2025-07-14 出版日期:2026-04-25
  • 通信作者: 邵幼林

Research progress on the clinical application of serum procalcitonin in severity assessment and antibiotic guidance for community-acquired pneumonia

Li Chen, Xinyi Gao, Xinyi Liu   

  • Received:2025-07-14 Published:2026-04-25
引用本文:

陈力, 高心怡, 刘心怡, 邵幼林. 血清降钙素原在社区获得性肺炎严重程度评估及抗生素使用指导中的临床应用研究进展[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(02): 341-345.

Li Chen, Xinyi Gao, Xinyi Liu. Research progress on the clinical application of serum procalcitonin in severity assessment and antibiotic guidance for community-acquired pneumonia[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(02): 341-345.

社区获得性肺炎(community-acquired pneumonia, CAP)是指在医院外罹患的感染性肺实质炎症,是呼吸系统常见疾病,发病率和病死率高。血清降钙素原(procalcitonin, PCT)是一种细菌感染相关标志物,在细菌感染时由甲状腺外组织产生并释放入血。PCT已从单纯的诊断标志物转向抗生素管理决策支持工具,不仅可辅助评估CAP的严重程度,还能指导抗生素治疗的启动、调整和停用决策,为精准抗感染治疗提供客观依据。在严重程度评估方面,PCT与传统临床评分系统(如CURB-65、PSI)联合应用可提高预后预测的准确性,动态监测PCT变化趋势较单次测量更具临床意义。在病原学诊断方面,PCT区分细菌性与病毒性肺炎的准确度为中等水平,其阴性预测价值优于阳性预测。非典型病原体(如肺炎支原体)感染时PCT升高不明显,易导致假阴性;肾功能不全患者PCT基线水平升高,阈值需个体化调整。目前,欧洲呼吸学会等国际指南已推荐将PCT用于指导CAP抗生素疗程,尤其是在停药决策中。PCT在特殊人群中的阈值设定、非典型病原体感染时的诊断局限性以及临床依从性等问题仍有待进一步研究。PCT在CAP诊断、治疗、预后评估等多方面的价值已被证实,未来结合动态监测与机器学习模型有望进一步提升PCT在CAP精准管理中的临床效能。

表1 PCT联合临床评分系统预测CAP预后的研究汇总
1
Aliberti S, Dela Cruz CS, Amati F, et al. Community-acquired pneumonia[J]. Lancet, 2021, 398(10303): 906-919.
2
Vaughn VM, Dickson RP, Horowitz JK, et al. Community-acquired pneumonia: a review[J]. JAMA, 2024, 332(15): 1282-1295.
3
Fan G, Zhou Y, Zhou F, et al. The mortality and years of life lost for community-acquired pneumonia before and during COVID-19 pandemic in China[J]. Lancet Reg Health West Pac, 2024, 42: 100968.
4
Liu YN, Zhang YF, Xu Q, et al. Infection and co-infection patterns of community-acquired pneumonia in patients of different ages in China from 2009 to 2020: a national surveillance study[J]. Lancet Microbe, 2023, 4(5): e330-e339.
5
Azzini AM, Dorizzi RM, Sette P, et al. A 2020 review on the role of procalcitonin in different clinical settings: an update conducted with the tools of the Evidence Based Laboratory Medicine[J]. Ann Transl Med, 2020, 8(9): 610.
6
Omaggio L, Franzetti L, Caiazzo R, et al. Utility of C-reactive protein and procalcitonin in community-acquired pneumonia in children: a narrative review[J]. Curr Med Res Opin, 2024, 40(12): 2191-2200.
7
Khilnani GC, Tiwari P, Zirpe KG, et al. Guidelines for the use of procalcitonin for rational use of antibiotics[J]. Indian J Crit Care Med, 2022, 26(Suppl 2): S77-s94.
8
Martin-Loeches I, Torres A, Nagavci B, et al. ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia[J]. Intensive Care Med, 2023, 49(6): 615-632.
9
Samsudin I, Vasikaran SD. Clinical Utility and Measurement of Procalcitonin[J]. Clin Biochem Rev, 2017, 38(2): 59-68.
10
Hui-Heng L, Jun-Sheng W, Jin-Zhou L, et al. LPS induced PCT production via TLR-4/NF-κB passway:it is the difference of G-/G+ bacteremia rats[J]. Cytokine, 2021, 137: 155317.
11
Le Y, Shi Y. MALAT1 regulates PCT expression in sepsis patients through the miR-125b/STAT3 axis[J]. J Clin Lab Anal, 2022, 36(5): e24428.
12
Hu Q, Bian Q, Rong D, et al. JAK/STAT pathway: Extracellular signals, diseases, immunity, and therapeutic regimens[J]. Front Bioeng Biotechnol, 2023, 11: 1110765.
13
薛海玲,房杰,陈明慧,等. 降钙素原检测在外科手术后应用的研究进展 [J]. 中国中西医结合外科杂志2021, 27(6): 917-919.
14
张少通,王博,张明瑞,等. 使用降钙素原轨迹识别脓毒症亚表型及风险分层研究[J]. 中国全科医学2025, 28(5): 594-600.
15
Molinari L, Del Rio-Pertuz G, Smith A, et al. Utility of biomarkers for sepsis-associated acute kidney injury staging[J]. JAMA Netw Open, 2022, 5(5): e2212709.
16
Ozbay S, Ayan M, Ozsoy O, et al. Diagnostic and prognostic roles of procalcitonin and other tools in community-acquired pneumonia: a narrative review[J]. Diagnostics (Basel), 2023, 13(11): 1869.
17
刘长英,吴春风. 成人重症社区获得性肺炎的流行病学及病原学特征分析[J]. 医药前沿2024, 45(2): 27-29,34.
18
Liu JX, Zhang Q, Bai JS, et al. Procalcitonin (PCT) improves the accuracy and sensitivity of CURB-65 score in predicting CAP patients admission to ICU[J]. Clin Lab, 2023, 69(1).doi: 10.7754/Clin.Lab.2022.220342.
19
Farhat I, Rosolowski M, Ahrens K, et al. Biomarkers troponin and procalcitonin in addition to CRB-65 enhance risk stratification in patients with community-acquired pneumonia[J]. ERJ Open Res, 2024, 10(6): 00420-2024.
20
Song Y, Sun W, Dai D, et al. Prediction value of procalcitonin combining CURB-65 for 90-day mortality in community-acquired pneumonia[J]. Expert Rev Respir Med, 2021, 15(5): 689-696.
21
张嘉宾,刘聪辉,付爱双,等. PCT、APTT联合PSI评分对老年CAP严重程度评估及预测预后的价值[J]. 华北理工大学学报(医学版), 2022, 24(03): 204-208, 216.
22
黄少辉,苏立勇,郑泳森. 动态监测降钙素原水平对评估老年社区获得性肺炎患者病情和预后的价值分析[J]. 内科2017, 5(12): 648-649.
23
Chen CH, Lee YT, Shen CF, et al. Dynamic cytokine monitoring enhances CAP severity scores in elderly patients: a prospective pilot study[J]. Intern Emerg Med, 2026, 21(2): 653-664.
24
潘晓萌,仲盛年. 重症社区获得性肺炎病原学及检测技术研究进展[J]. 临床个性化医学2024, 3(1): 135-140.
25
Martin-Loeches I, Torres A. New guidelines for severe community-acquired pneumonia[J]. Curr Opin Pulm Med, 2021, 27(3): 210-215.
26
Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among U.S. Adults[J]. N Engl J Med, 2015, 373(5): 415-427.
27
Shoar S, Musher DM. Etiology of community-acquired pneumonia in adults: a systematic review[J]. Pneumonia, 2020, 12: 11.
28
薛格艳,薛莎,石佳鑫,等. 婴幼儿社区获得性肺炎病原学特征分析[J]. 中国病原生物学杂志2025, 20(4): 512-516.
29
Kamat IS, Ramachandran V, Eswaran H, et al. Procalcitonin to distinguish viral from bacterial pneumonia: a systematic review and meta-analysis[J]. Clin Infect Dis, 2020, 70(3): 538-542.
30
Self WH, Balk RA, Grijalva CG, et al. Procalcitonin as a marker of etiology in adults hospitalized with community-acquired pneumonia[J]. Clin Infect Dis, 2017, 65(2): 183-190.
31
Wei S, Wang L, Lin L, et al. Predictive values of procalcitonin for coinfections in patients with COVID-19: a systematic review and meta-analysis[J]. Virol J, 2023, 20(1): 92.
32
Patel N, Adams C, Brunetti L, et al. Evaluation of procalcitonin′s utility to predict concomitant bacterial pneumonia in critically Ⅲ COVID-19 patients[J]. J Intensive Care Med, 2022, 37(11): 1486-1492.
33
Schuetz P, Christ-Crain M, Thomann R, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial[J]. JAMA, 2009, 302(10): 1059-1066.
34
Kyriazopoulou E, Liaskou-Antoniou L, Adamis G, et al. Procalcitonin to reduce long-term infection-associated adverse events in sepsis. a randomized trial[J]. Am J Respir Crit Care Med, 2021, 203(2): 202-210.
35
Lhopitallier L, Kronenberg A, Meuwly JY, et al. Procalcitonin and lung ultrasonography point-of-care testing to determine antibiotic prescription in patients with lower respiratory tract infection in primary care: pragmatic cluster randomised trial[J]. BMJ, 2021, 374: n2132.
36
Duijkers R, Prins HJ, Kross M, et al. Biomarker guided antibiotic stewardship in community acquired pneumonia: A randomized controlled trial[J]. PLoS One, 2024, 19(8): e0307193.
37
刘瑶,吴金桓,范铭兴,等. 动态监测降钙素原对重症社区获得性肺炎患儿抗感染治疗的临床研究[J]. 中华全科医学2023, 21(2): 186-189.
38
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.
39
Kubo K, Sakuraya M, Sugimoto H, et al. Benefits and harms of procalcitonin- or c-reactive protein-guided antimicrobial discontinuation in critically Ⅲ adults with sepsis: a systematic review and network meta-analysis[J]. Crit Care Med, 2024, 52(10): e522-e534.
40
Chambliss AB, Patel K, COLóN-Franco JM, et al. AACC guidance document on the clinical use of procalcitonin[J]. J Appl Lab Med, 2023, 8(3): 598-634.
41
中国医师协会急诊医师分会, 北京急诊医学学会. 急诊成人社区获得性肺炎临床实践指南(2024年版)[J]. 中华急诊医学杂志2025, 34(3): 300-317.
42
Siriwardena AK, Jegatheeswaran S, Mason JM. A procalcitonin-based algorithm to guide antibiotic use in patients with acute pancreatitis (PROCAP): a single-centre, patient-blinded, randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2022, 7(10): 913-921.
43
Slieker JC, Aellen S, Eggimann P, et al. Procalcitonin-guided antibiotics after surgery for peritonitis: a randomized controlled study[J]. Gastroenterol Res Pract, 2017, 2017: 3457614.
44
Drozdov D, Schwarz S, Kutz A, et al. Procalcitonin and pyuria-based algorithm reduces antibiotic use in urinary tract infections: a randomized controlled trial[J]. BMC Med, 2015, 13: 104.
45
Serena V, Alessandro M, MaurizioTerrazzini Nadia ,et al. Baseline haematological and biochemical reference values for healthy male adults from Mali[J]. Pan Afr Med J, 2019, 32: 5.
46
Gavazzi G, Drevet S, Debray M, et al. Procalcitonin to reduce exposure to antibiotics and individualise treatment in hospitalised old patients with pneumonia: a randomised study[J]. BMC Geriatr, 2022, 22(1): 965.
47
Wu SC, Liang CX, Zhang YL, et al. Elevated serum procalcitonin level in patients with chronic kidney disease without infection: A case-control study[J]. J Clin Lab Anal, 2020, 34(2): e23065.
48
Langford BJ, Beriault D, Schwartz KL, et al. A real-world assessment of procalcitonin combined with antimicrobial stewardship in a community ICU[J]. J Crit Care, 2020, 57: 130-133.
49
Gupta S, Klompas M, Rhee C. Reassessing procalcitonin-guided antibiotic therapy in critically Ⅲ patients with sepsis: lessons from the ADAPT-sepsis trial[J]. Clin Infect Dis, 2025. DOI: 10.1093/cid/ciaf336.
50
Nielsen MJ, Baines P, Jennings R, et al. Procalcitonin, C-reactive protein, neutrophil gelatinase-associated lipocalin, resistin and the APTT waveform for the early diagnosis of serious bacterial infection and prediction of outcome in critically ill children[J]. PLoS One, 2021, 16(2): e0246027.
51
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