降钙素原 (PCT) – 辅助诊断脓毒症的生物标记物

降钙素原被公认为是反映严重全身炎症反应、感染和脓毒症的最有用的生物标志物,是急诊和ICU医生辅助诊断脓毒症的关键手段[1]

包含116个氨基酸多肽的降钙素原,已经成为辅助诊断细菌性脓毒症最敏感的生物标志物。主要由甲状腺C细胞合成,肺、肠道等其它器官的神经内分泌组织亦能合成少量降钙素原,通常在血液中的浓度很低。

然而,它可以由炎性细胞因子和细菌内毒素刺激产生,作为对感染,特别是全身细菌感染的反应,降钙素原被大量释放。

降钙素原作为炎症反应的生物标志物,预示脓毒症风险,浓度越高,全身感染和脓毒症的可能性越大 [1]。

Higher PCT levels indicate an increasing risk for sepsis

Adapted from Harbarth S et al. Am J Respir Crit Care Med 2001, 164: 396-402

因为对大多数细菌的高灵敏度 [2],降钙素原公认为辅助诊断脓毒症最敏感的生物标志物,同时因其高达95%的阴性预测值 [2, 3]。降钙素原也被作为脓毒症的排除诊断。

相较于经常用来辅助诊断脓毒症的另外一个标志物-C反应蛋白,降钙素原半衰期更短,细菌感染时浓度升高更快 [4, 5]。

检测PCT可以早期发现脓毒症。

Measuring PCT enables early indication of sepsis

Adapted from Kumar Meisner et al., Crit Care 1999, 3:45-50

怀疑脓毒症但是无法确诊,同时降钙素原升高,那么要考虑抗生素治疗,随后进行血液检查,确认血液中的病原微生物。这通常涉及血培养,可能需要几天时间,但血培养通常不能反映全身炎症和器官衰竭 [6]。

雷度米特开发了快速、便于操作的PCT测试来辅助诊断脓毒症,21分钟内出结果。

 

       
  1. Riedel S, et al. Procalcitonin as a marker for the detection of bacteremia and sepsis in the emergency department. Am J Clin Pathol 2011; 135: 182-89.
  2. Lee SH, Chan RC, Wu JY, et al. Diagnostic value of procalcitonin for bacterial infection in elderly patients – a systemic review and meta-analysis. Int J Clin Pract 2013; 67:1350-57.
  3. Becker KL, Snider R, Nylen ES. Procalcitonin assay in systemic inflammation, infection, and sepsis: Clinical utility and limitations. Crit Care Med 2008; 36,3: 941-52.
  4. McGee KA, Bauman NA. Procalcitonin, clinical utility in diagnosing sepsis. Clin Lab News 2009; 35,7: 1-8.
  5. O’Grady NP, Barie PS, Bartlett JG, Bleck T, Carroll K, Kalil AC, et al. Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Crit Care Med 2008; 36,4: 1330-49.
  6. Schuetz P, Christ-Crain M, Müller B. Procalcitonin and other biomarkers for the assessment of disease severity and guidance of treatment in bacterial infections. Adv Sepsis 2008; 6,3: 82-89

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