降钙素原在新生儿感染诊断及病情监测中的价值

目的探讨降钙素原(procalcitonin,PCT)在新生儿感染诊断及病情监测中的价值。方法收集2017年1月至12月在清华大学第一附属医院儿科住院的新生儿348例,分为重症感染组、局部感染组和非感染性疾病对照组,检测患者血清PCT水平,评估其对新生儿感染的临床价值。结果重症感染组PCT水平高于局部感染组和对照组,局部感染组PCT和CRP水平高于对照组,差异均有统计学意义(P<0.05)。PCT高值组住院周期高于中值组和低值组,中值组住院周期高于低值组,差异均有统计学意义(P<0.05)。当PCT≥0.5ng/mL时,其诊断灵敏度和特异性分别为72.9%和97.1%;当PCT≥2ng/mL时,其诊断灵敏度和特异性分别为37.8%和99.7%。结论PCT是一种敏感且特异的新生儿感染的诊断指标,PCT水平的高低还可用于新生儿感染的病情监测。     

血清降钙素原在儿童细菌感染性疾病诊断中的意义

目的 探讨血清降钙素原(PCT)在儿童细菌感染性疾病中的诊断价值.方法 通过对我院已诊断为细菌感染的137例病例测定PCT,并与其他非细菌感染的80例病例进行比较.结果 感染病例与非感染病例比较有显著性差异(P≤0.01).结论 PCT是诊断儿童细菌感染性疾病目前最敏感的特异性指标,亦是鉴别病毒感染和细菌感染的可靠指标.     

降钙素原定量检测在鉴别细菌和病毒感染中的诊断意义

目的:检测降钙素原(PCT)定量检测在鉴别细菌和病毒感染中的诊断价值,为PCT在感染性疾病中的应用提供实验依据.方法:采用定量固相免疫测定119例患者的PCT浓度,其中87例细菌感染患者、5例脓毒症患者、27例病毒感染患者和30例正常体检者,同时测定C反应蛋白(CRP)的浓度.以此分析PCT和CRP感染指标在病毒感染和细菌感染中的浓度变化.结果:细菌感染组、脓毒症组、病毒感染组和健康组的PCT水平分布存在统计学差异(P<0.01);细菌感染组显著高于病毒感染组和健康组(P<0.01);脓毒症组显著高于病毒感染组和健康组(P<0.01);但病毒感染组与健康组之间无统计学意义(P>0.05).结论:PCT定量检测对于细菌性感染是一个敏感的新指标,比CRP体现出更好的灵敏度及特异性.而在病毒感染的患者中,PCT结果始终处于比较低的浓度水平.     

降钙素原在败血症中的临床意义

血清降钙素(procalcitonin,PCT)是正常人血清中存在的含116个氨基酸的糖蛋白。败血症时,血浆PCT水平明显升高。与传统的感染检测指标相比,PCT具有灵敏、特异、可早期检测特点,而且PCT水平与疾病的严重程度相一致。     

利用降钙素原判断细菌感染的临床符合性分析

目的通过实验室数据和临床综合诊断分析血清降钙素原（PCT）在判断细菌感染中的临床符合性。方法对诊断感染的常规指标C反应蛋白（CRP）、白细胞计数（WBC）、中性粒细胞比例（N％）和细菌培养与PCT进行判断感染的临床符合性分析,再对PCT与临床综合诊断结论进行统计学分析来判断感染和非感染,以及不同部位感染的差异。结果当PCT大于0．5ng／ml时与常规指标的符合性大于92％,而且随着PCT的增大符合性进一步增加;PCT与常规指标之间除CRP外均差异有统计学意义（P〈0．01）;PCT的ROC曲线下面积大于全部常规指标;细菌感染与非感染组间PCT差异有统计学意义（P〈0．01）,但对肿瘤合并感染情况较难判断;PCT全身感染与局部感染之间除伤口感染外均差异有统计学意义（P〈0．01）,但在不同部位间差异无统计学意义。结论PCT与临床广泛应用判断感染的常规指标具有较好的吻合性,PCT在判断细菌感染方面选各医院适用的CUTOFF值能起到很好的作用,可以替代常规指标。     

儿童呼吸道感染疾病检测降钙素原的临床价值

儿童呼吸道感染是儿科常见的临床疾病,60%以上由病毒引起,呼吸系统病毒通过损伤呼吸道上皮促进气道继发细菌感染.虽然病毒感染是主要原因之一,但儿童感染性疾病鉴别诊断是常见而又棘手的难题,其确诊主要依赖于血培养.     

血清降钙素原测定在指导下呼吸道感染抗生素治疗的价值

目的:评价动态监测血清降钙素原(procalcitonin,PCT)在指导下呼吸道感染抗菌治疗中的临床价值。方法:选取90例医院获得性下呼吸道感染患者,根据应用抗生素的最终临床指标分为对抗生素治疗有效组(A组)和对抗生素治疗无效组(B组),观察确诊感染后第1、3、5、7d两组患者的血清PCT水平变化,并采用ROC曲线下面积观察PCT评估抗菌疗效的价值。结果:两组患者确诊感染后的第1d血清PCT水平比较无明显差异(P>0.05);而第3、5、7d A组患者血清PCT水平逐渐下降,而B组患者PCT水平则明显升高,两组比较有统计学差异(P<0.05)。第1、3、5、7d PCT水平指示抗菌无效的ROC曲线下面积分别为0.447、0.716、0.981、1.000,其中第3、5、7d PCT的ROC曲线下面积与第1d PCT的ROC曲线下面积比较差异均有显著性(P<0.05);抗生素治疗第5d,以PCT水平3.095μg/L为截点,判断抗生素治疗无效的灵敏度和特异性分别为97.4%和91.0%。结论:在医院获得性下呼吸道感染抗菌治疗过程中,动态监测PCT水平可作为优化抗生素治疗的有效指标。     

降钙素原检测诊断肺结核合并肺部细菌感染的价值

目的 分析肺结核合并肺部细菌感染患者检测降钙素原（PCT）在临床诊断中的重要价值。方法 回顾分析2018年4月~2019年4月在我院诊治的112例肺结核患者临床资料,将未合并肺部感染69例设为未合并组,将合并肺部感染43例设为合并组。合并组给予抗菌治疗,依据抗菌效果分为控制组和未控制组,比较合并组与未合并组、控制组和未控制组治疗前后血清PCT水平。结果 合并组血清PCT高于未合并组,差异有统计学意义（P＜0.05）;控制组和未控制组治疗前血清PCT比较,差异无统计学意义（P＞0.05）;治疗后控制组血清PCT低于治疗前,且控制组低于未控制组,差异有统计学意义（P＜0.05）;合并组43例患者,肺部细菌感染的ROC曲线下面积为0.941,95%CI:0.896~0.983,临界值为0.674 μg/L,PCT检测敏感度为86.04%（37/43）,特异度94.87%（37/39）。结论 肺结核合并肺部细菌感染患者血清PCT监测,有助于判断患者是否合并肺部感染及抗菌药物治疗效果,为临床诊断和指导抗菌药提供一定的参考。     

降钙素原及超敏C反应蛋白检测对新生儿感染的临床意义

目的研究降钙素原(procalcitonin,PCT)及超敏C反应蛋白(high- sensitivity C- reactive protein,hs- CRP)检测对新生儿感染的临床意义。方法 2016年10月至2017年9月期间就诊于本院的100例疑似新生儿感染患者作为研究对象。患儿首先进行血清降钙素原、超敏C反应蛋白、白细胞计数等多项指标检查,结合临床症状及其他方法确诊后,分为感染组和非感染组,例数分别为60例和40例。感染组患儿经对症治疗后,再次检测血清降钙素原、超敏C反应蛋白、白细胞计数等多项指标检查,比较组间差异。另外统计降钙素原、超敏C反应蛋白的阳性诊断率,比较组间差异。结果①感染组患儿治疗前血清CRP、PCT、WBC、NEU等指标水平显著高于非感染组,差异具有统计学意义, P <0.05;治疗后,感染组各指标较治疗前显著降低,差异具有统计学意义, P <0.05。②感染组51例患儿hs- CRP呈阳性,56例PCT呈阳性,非感染组4例hs- CRP阳性,3例PCT呈阳性。感染组hs- CRP、PCT的阳性率分别为85.0%和93.3%,显著高于非感染组的10.0%和7.5%, P <0.05。结论血清降钙素原及超敏C反应蛋白检测对新生儿感染的诊断和治疗具有指导意义,值得推广。     

降钙素原变化率在重症肺炎患者中的诊断价值

目的 探讨降钙素原变化率在重症肺炎患者中的诊断价值.方法 自2017年1月至2018年1月,前瞻性收集我院收治的重症肺炎患者92例.根据患者降钙素原变化率将患者分为A组[(24h降钙素原—入院时降钙素原)／入院时降钙素原≤-20％]和B组[(24h降钙素原-入院时降钙素原)／入院时降钙素原＞-20％].观察两组患者临床预后.结果 与B组比较,A组患者呼吸机时间(d)显著缩短(16.24±3.81 vs.18.22 ±3.62 d,P=0.013);抗菌素时间显著缩短(7.12±1.88 vs.8.57-±1.92 d,P＜0.001);血管活性药物时间缩短(8.12 ±1.88 vs.9.65 ±1.65 d,P＜0.001);脓毒症发生率显著降低(27.50％ vs.48.08％,P=0.045).结论 24h内降钙素原变化率＞-20％是患者预后不良的主要因素,应加强临床干预.     

The role of procalcitonin in a decision tree for prediction of bloodstream infection in febrile patients

Bloodstream infection (BSI) in febrile patients is associated with high mortality. Clinical and laboratory variables, such as procalcitonin (PCT), may predict BSI and help decision-making concerning empirical treatment. This study compared two models for prediction of BSI, and evaluated the role of PCT vs. clinical variables, collected daily in 300 consecutive febrile inpatients, for 48 h after onset of fever. Multiple logistic regression (MLR) and classification and regression tree (CART) models were compared for discriminatory power and diagnostic performance. BSI was present in 17% of cases. MLR identified the presence of intravascular devices, nadir albumin and thrombocyte counts, and peak temperature, respiratory rate and leukocyte counts, but not PCT, as independent predictors of BSI. In contrast, a peak PCT level of >2.45 ng/mL was the principal discriminator in the decision tree based on CART. The latter was more accurate (94%) than the model based on MLR (72%; p <0.01). Hence, the presence of BSI in febrile patients is predicted more accurately and by different variables, e.g., PCT, in CART analysis, as compared with MLR models. This underlines the value of PCT plus CART analysis in the diagnosis of a febrile patient.     

Overview of procalcitonin in pregnancy and in pre-eclampsia

Procalcitonin (PCT), a precursor for calcitonin, is a prohormone involved in the inflammatory processes, which has been poorly studied in the context of pregnancy. During severe inflammation, PCT derives from almost all cell types, including monocytes and parenchymal tissues, making it a good predictive and diagnostic marker of an inflammatory state with rapidly increased serum levels in inflammation or sepsis. In normal pregnancy, PCT is basally expressed at very low level by decidual cells, even if decidual macrophages, which in normal pregnancy are skewed to M2 macrophages, are resistant to lipopolysaccharide (LPS)-induced production of PCT. As PCT increase is associated with an inflammatory state, several research groups investigated whether PCT can be considered a marker of pre-eclampsia, a pregnancy disease characterized by systemic inflammation. The first aim of this review is to summarize what is already known about the tissues synthesizing PCT, about the stimuli that cause the increase of circulating PCT levels and how PCT acts as a proinflammatory stimulus by itself. Secondly, we will describe the role of this prohormone in normal pregnancy and in pregnancies complicated by pre-eclampsia, highlighting the involvement of the decidual macrophages and the proinflammatory cytokine tumor necrosis factor-α in the modulation of PCT expression in the decidual microenvironment.     

Defensin-based anti-infective strategies

Cationic and amphiphilic peptides are widely distributed in eukaryotic organisms and constitute a first line of host defense against invading pathogens. Some of these host defense peptides (HDPs) combine specific antibiotic activities with modulation of immune responses. Moreover, they are active against bacteria resistant to conventional antibiotics and show only modest resistance development under in vitro selection pressure. Based on these features, HDPs and particularly defensins are considered a promising source of novel anti-infective agents.     

Prognostic value of pro-adrenomedullin,procalcitonin and C-reactive protein in predicting outcome of febrile urinary tract infection

Bacterial infections such as febrile urinary tract infection (fUTI) may run a complicated course that is difficult to foretell on clinical evaluation only. Because the conventional biomarkers erythrocyte sedimentation rate (ESR), leucocyte count, C-reactive protein (CRP) and procalcitonin (PCT) have a limited role in the prediction of a complicated course of disease, a new biomarker—plasma midregional pro-adrenomedullin (MR-proADM)—was evaluated in patients with f UTI. We conducted a prospective multicentre cohort study including consecutive patients with f UTI at 35 primary-care centres and eight emergency departments. Clinical and microbiological data were collected and plasma biomarker levels were measured at presentation to the physician. Survival was assessed after 30 days. Of 494 fUTI patients, median age was 67 (interquartile range 49-78) years, 40% were male; two-thirds of them had significant co-existing medical conditions. Median MR-proADM level was 1.42 (interquartile range 0.67-1.57) nM; significantly elevated MR-proADM levels were measured in patients with bacteraemia, those admitted to the intensive care unit, and in 30-day and 90-day non-survivors, compared with patients without these characteristics. The diagnostic accuracy for predicting 30-day mortality in fUTI, reflected by the area-under-the-curve of receiver operating characteristics were: MR-proADM 0.83 (95% CI 0.71-0.94), PCT 0.71 (95% CI 0.56-0.85); whereas CRP, ESR and leucocyte count lacked diagnostic value in this respect. This study shows that MR-proADM assessed on first contact predicts a complicated course of disease and 30-day mortality in patients with fUTI and in this respect has a higher discriminating accuracy than the currently available biomarkers ESR, CRP, PCT and leucocyte count.     

降钙素原在病毒性脑膜炎和细菌性脑膜炎鉴别诊断中的应用

目的探讨降钙素原（PCT）在病毒性脑膜炎和细菌性脑膜炎鉴别诊断中的应用价值。方法通过对27例细菌性脑膜炎和32例病毒性脑膜炎患者血清PCT值的检测和比较,从而分析降钙素原在其鉴别诊断中的临床意义。结果细菌性脑膜炎患者血中的PCT平均浓度为37.84 ng/ml,病毒性脑膜炎患者的PCT平均浓度为0.41 ng/ml,两者相比差异有统计学意义（χ2=28.45,P〈0.01）,特异性分别为100%和96.9%。结论降钙素原对病毒性脑膜炎和细菌性脑膜炎的鉴别诊断具有临床应用价值。     

Dynamics of serum procalcitonin in patients after major neurosurgery

Classical markers of infection cannot differentiate reliably between inflammation and infection after neurosurgery. This study investigated the dynamics of serum procalcitonin (PCT) in patients following major neurosurgery. PCT concentrations remained < 0.2 ng/mL during the post-operative course. In contrast, leukocyte and neutrophil counts, as well as C-reactive protein (CRP) levels, increased significantly post-operatively (leukocytes, range 7.1-23.7 x 10(9)/L, p < 0.001; neutrophils, range 70.8-94.5%, p < 0.001; CRP, median 14 mg/L, range 3-95 mg/L, p < 0.001). Analysis of PCT levels using assays with improved sensitivity may be useful in the diagnosis of neurosurgical patients with post-operative fever of unknown origin.