降钙素原指导慢性阻塞性肺疾病急性加重期患者的抗菌药物使用

目的探讨降钙素原在指导慢性阻塞性肺疾病急性加重期(AECOPD)患者抗菌药物使用方面的价值。方法选取2014年3月至2015年9月航天中心医院呼吸科诊治的AECOPD患者184例,采用随机数字表法分为对照组和观察组两组,各92例。对照组患者根据临床经验实施抗菌药物治疗,观察组患者根据血清降钙素原浓度实施抗菌药物治疗。结果观察组患者治疗后降钙素原水平较治疗前显著降低(P0.05)。观察组患者治疗后降钙素原、半年内再次急性加重发生率、半年内再住院率低于对照组(P0.05)。观察组患者抗菌药物使用时间、抗菌药物费用、住院时间、住院费用少于对照组(P0.05)。两组患者治疗总有效率、住院病死率比较,差异无统计学意义(P0.05)。结论 AECOPD患者血清降钙素原显著升高,参考降钙素原水平有助于优化抗菌药物的使用。     

Procalcitonin may help differentiate disseminated herpes simplex viral infection from bacterial sepsis in neonates

Disseminated herpes simplex virus infection is a potentially fatal condition which may be difficult to differentiate from bacterial sepsis. We report the case of a neonate with overwhelming herpes simplex (type 2) viraemia who presented with `septic shock'. Conclusion A low procalcitonin level (1.6 ng/ml), inconsistent with bacteraemia, suggests an alternative aetiology and may strengthen the case for antiviral therapy. Received: 28 March 1999 / Accepted: 10 August 1999     

降钙素原在全身炎症反应综合征鉴别诊断和监测中的作用

目的评价在出现全身炎症反应综合征(SIRS)表现早期,降钙素原(PCT)、白细胞介素-6(IL-6)以及传统指标对于感染性和非感染性病因的鉴别作用,及其与病情严重程度的相关性.方法采用前瞻性研究,共有30例非感染性SIRS和27例感染性SIRS患者人选,在出现临床表现24 h内测定血清PCT、IL-6和C反应蛋白(CRP)水平,同时记录最高体温、白细胞计数、中性粒细胞比例及绝对计数等,做急性生理和慢性健康评分(APACHEⅡ)及全身性感染相关器官衰竭评分(SOFA).结果感染性SIRS患者与非感染性SIRS患者相比,血清PCT(5.54[1.20,32.74]μg/L vs 0.77[0.22,3.90]μg/L,P=0.001)、IL-6(163.66[33.60,505.26]ng/L vs 37.72[22.52,110.78]ng/L,P=0.004)、CRP([15.28±8.41]g/L vs [9.51±7.65]g/L,P=0.010)和中性粒细胞比例(0.91±0.04 vs 0.88±0.04,P=0.010)水平显著升高.受试者工作特征曲线表明,PCT和IL-6的鉴别力最佳.血清PCT和IL-6水平与患者的APACHEⅡ评分及SOFA评分显著相关,血清PCT水平和住院日呈正相关.结论与传统炎症指标相比,PCT和IL-6有助于鉴别感染性和非感染性SIRS,并且和病情严重程度有一定相关性.     

Effect of inflammatory attacks in the classical type hyper-IgD syndrome on immunoglobulin D, cholesterol and parameters of the acute phase response

BACKGROUND: Classical type hyper-immunoglobulin D (IgD) syndrome (HIDS) is an hereditary auto-inflammatory disorder, characterized by recurrent episodes of fever, lymphadenopathy, abdominal distress and a high serum concentration of IgD. It is caused by mevalonate kinase deficiency. OBJECTIVE: To further characterize the acute phase response during fever attacks in HIDS in order to improve diagnosis. SUBJECTS: Twenty-two mevalonate kinase-deficient HIDS patients. METHODS: Blood samples were drawn during and in between febrile attacks, and concentrations ofC-reactive protein (CRP), ferritin, procalcitonin, pentraxin 3, IgD and cholesterol in several lipoprotein fractions were determined. RESULTS: The marked acute phase response at the time of a fever attack in classical type HIDS is reflected by a rise in CRP accompanied by a moderate but statistically significant rise in procalcitonin and pentraxin 3. In only two of 22 patients, procalcitonin concentration rose above 2 ng mL(-1) during fever attack, compatible with the noninfectious nature of these attacks. Ferritin does not reach the high concentrations found in adult-onset Still's disease. Despite the defect in mevalonate kinase, a component of cholesterol metabolism, serum cholesterol did not change during attacks. IgD concentration is elevated regardless of disease activity, although there is appreciable variation during life. Its role in HIDS remains unclear. CONCLUSION: The combination of high CRP concentration plus procalcitonin concentration <2 ng mL(-1) in a symptomatic HIDS patient might indicate a febrile attack without (bacterial) infection; this observation warrants further investigation for its usefulness as a marker in clinical practice.     

Postnatal increase of procalcitonin in premature newborns is enhanced by chorioamnionitis and neonatal sepsis

BACKGROUND: To determine the influence of chorioamnionitis and neonatal sepsis on procalcitonin (PCT) levels in very-low-birth-weight (VLBW) infants within the first week of life. DESIGN: PCT serum levels were measured in cord blood 1 h after delivery and on day 3 and day 7 of life. Chorioamnionitis and neonatal sepsis within the first week were monitored. RESULTS: Chorioamnionitis was present in eight of 37 patients (21.6%). PCT on day 3 was increased in both the "No chorioamnionitis" (2.54 ng mL(-1), SEM 0.51) and "Chorioamnionitis" (6.96 ng mL(-1), SEM 2.93) groups of VLBW infants compared with the 1st hour values (0.45 and 0.58 ng mL(-1) SEM 0.07 and 0.11, respectively, P < 0.001) of the same patients. The postnatal gain was higher in the "Chorioamnionitis" group (P < 0.01). Neonatal sepsis was diagnosed (after exclusion) in 12 of 32 patients (37.5%). Mean values of maximum PCT in patients with and without sepsis were 8.41 ng mL(-1) (SEM 1.87) and 3.02 ng mL(-1) (SEM 1.38), respectively (P < 0.05). Sensitivity to sepsis of PCT, ratio of immature to total neutrophils (I : T), and C-reactive protein (CRP) were 75%, 50% and 25%, respectively. CONCLUSIONS: In the group of VLBW infants the PCT level within 72 h of delivery was markedly increased in patients with chorioamnionitis. Compared with I : T and CRP, PCT appears to be a more sensitive marker of neonatal sepsis.     

Measurements in the intensive care unit: what do they mean?

Intensivists depend upon a large number of measurements to make daily decisions in the ICU. However, the reliability of these measures may be jeopardized by the effects of therapy. Moreover, in critical illness, what is normal is not necessarily optimal. Procalcitonin, a putative marker of occult infection, is emerging as a valuable diagnostic marker in the ICU. Although questions remain regarding its specificity, an increasing body of work suggests that it is reliably elevated in the setting of infection. As demonstrated by Level and colleagues in this issue of Critical Care, its utility as a diagnostic marker is not affected by concomitant hemodialysis.     

血清降钙素水平在慢性泌尿系统感染定位诊断中的价值

目的:探讨降钙素原(PCT)对慢性上、下尿路感染的诊断价值。方法:回顾性分析临床确诊慢性肾盂肾炎(CPN)及慢性膀胱炎(CC)的患者血清PCT、全血白细胞(WBC)的变化,判断PCT与泌尿系感染之间的定位关系。PCT的测定采用金标(LUM Itest)法。结果:慢性肾盂肾炎患者组PCT值明显高于下尿路感染组,当血清PCT≥0.5μg/L时,预测肾脏受累的灵敏性和特异性分别为86%和91%,并且随着感染的加重而增加,随着治疗的好转而减少。结论:血清PCT水平的检测对鉴别慢性上、下尿路感染有一定的参考意义。     

Procalcitonin in sepsis and systemic inflammation: a harmful biomarker and a therapeutic target

The worldwide yearly mortality from sepsis is substantial, greater than that of cancer of the lung and breast combined. Moreover, its incidence is increasing, and its response to therapy has not appreciably improved. In this condition, the secretion of procalcitonin (ProCT), the prohormone of calcitonin, is augmented greatly, attaining levels up to thousands of fold of normal. This hypersecretion emanates from multiple tissues throughout the body that are not traditionally viewed as being endocrine. The serum values of ProCT correlate with the severity of sepsis; they recede with its improvement and worsen with exacerbation. Accordingly, as highlighted in this review, serum ProCT has become useful as a biomarker to assist in the diagnosis of sepsis, as well as related infectious or inflammatory conditions. It is also a useful monitor of the clinical course and prognosis, and sensitive and specific assays have been developed for its measurement. Moreover, it has been demonstrated that the administration of ProCT to septic animals greatly increases mortality, and several toxic effects of ProCT have been elucidated by in vitro experimental studies. Antibodies have been developed that neutralize the harmful effects of ProCT, and their use markedly decreases the symptomatology and mortality of animals that harbour a highly virulent sepsis analogous to that occurring in humans. This therapy is facilitated by the long duration of serum ProCT elevation, which allows for a broad window of therapeutic opportunity. An experimental groundwork has been established that suggests a potential applicability of such therapy in septic humans.     

GeneXpert 联合基因芯片在涂阴 MTB 诊断中的价值及患者血清 sTREM-1、 PCT 水平及意义

目的 探讨利福平耐药实时荧光定量核酸扩增技术 ( rifampicin resistant real-time fluorescent quantitative nucleic acid amplification, GeneXpert MTB/ RIF) 联合基因芯片技术在涂阴结核分支杆菌 (Mycobacterium tuberculosis, MTB) 诊断中的价值及血清可溶性髓系细胞触发受体-1 ( serum soluble triggering receptor-1, sTREM-1)、 降钙素原 (procalcitonin, PCT) 水平的意义。 方法 选取 2019 年 1 月至 2021 年 1 月在聊城市 人民医院就诊的疑似涂阴肺结核患者130 例, 采集肺泡灌洗液, 给予 GeneXpert MTB/ RIF、 基因芯片及药敏 试验检查, 同时检查肺结核患者血清 sTREM-1、 PCT 水平。 以肺泡灌洗液结核菌培养及药敏试验为金标准 评价 GeneXpert MTB/ RIF 联合基因芯片检测对涂阴肺结核的诊断价值。 采用 ROC 评价血清 sTREM-1、 PCT 对涂阴肺结核的诊断价值。 结果 以肺泡灌洗液结核菌培养诊断出非涂阴肺结核患者 58 例, 涂阴肺结核患 者 72 例。 GeneXpert MTB/ RIF 联合基因芯片诊断肺结核的灵敏性为 68. 06 % , 高于基因芯片单独诊断 (P< 0. 05), GeneXpert MTB/ RIF 联合基因芯片诊断肺结核的特异性、 准确性、 阳性预测值和阴性预测值分别为 91. 38 % 、 78. 46 % 、 90. 74 % 和 69. 74 % , 与 GeneXpert MTB/ RIF 诊断、 基因芯片单独诊断比较差异无统 计学意义 (P> 0. 05); GeneXpert MTB/ RIF 联合基因芯片诊断 MDR-TB 的灵敏性、 特异性、 准确性、 阳性 预测值和阴性预测值分别为 94. 12 % 、 85. 45 % 、 87. 50 % 、 66. 67 % 和 97. 92 % , 与 GeneXpert MTB/ RIF 诊断基因芯片单独诊断比较差异无统计学意义 (P> 0. 05); 重症肺结核患者血清 sTREM-1、 PCT 分别为 (18. 04 ± 2. 07) ng / ml 和 (2. 09 ± 0. 19) ng / ml, 明显高于轻症肺结核患者 ( P< 0. 05); 血清 sTREM-1、 PCT 预测重症肺结核的 ROC 曲线下面积分别为 0. 811 和 0. 844, 截断值分别为 16. 32 ng / ml 和 2. 00 ng / ml, 灵敏性分别为 89. 30 % 和 82. 00 % , 特异性分别为 61. 40 % 和 79. 60 % 。 结论 GeneXpert 联合基因芯片技 术可提高涂阴 MTB 诊断灵敏性, 且两种手段对 MDR-TB 均有较好的诊断价值。 重症肺结核患者 sTREM-1、 PCT 水平明显高于轻症肺结核, 血清 sTREM-1、 PCT 对重症肺结核诊断灵敏性、 特异性较高, 可作为早期 诊断的手段加以应用。     

Significance of lipopolysaccharide-binding protein (an acute phase protein) in monitoring critically ill patients

Introduction  

The present study was conducted to assess the value of serum concentration of lipopolysaccharide-binding protein (LBP) in patients with systemic inflammatory response syndrome (SIRS), sepsis and septic shock with respect to its ability to differentiate between infectious and noninfectious etiologies in SIRS and to predict prognosis.