降钙素原在感染中的应用及研究进展

降钙素原(procalcitonin,PCT)作为一种系统性炎症介质,是近年来备受关注的新型炎症标志物之一。在临床应用中,相较于WBC、IL-6、CRP等生物学指标,PCT拥有相对较高的灵敏度和特异性,能够更有效的区别细菌感染和其他炎症过程。PCT不仅是筛查感染性疾病的良好指标,而且PCT在病毒感染、细菌感染(G+菌及G-菌)、真菌感染或是其他非典型病原菌感染中的浓度有所差异,故也是鉴别不同病原菌感染的有效指标。PCT起始浓度对于启用抗生素治疗有一定的指导意义,而在整个治疗过程中PCT的监测管理对于是否继续使用或是停用抗生素也尤为重要,血中PCT的动态变化对于评估疾病感染的严重程度及预后、判断疗效等方面也具有重要意义。与此同时,PCT指导抗生素的治疗可减少抗生素使用疗程、缩短患者的住院时间及降低住院费用,从而在整体上减少抗生素耐药率的发生、减少社会成本和增加社会效益。虽然目前对于PCT的研究很多,但是在不同的研究中,由于PCT检测手段不同、实验设计不同、选择偏移等的存在,对于鉴别感染类型、疾病严重程度及预后的临界值难以统一界定。而PCT对于指导抗生素治疗的成本-效益评估缺乏大样本以及强有力的证据支持,故仍需进一步探讨研究。本文就降钙素原在临床感染中的应用及研究进展做一综述。 

The clinical application and research progress of procalcitonin in infectious diseases

As an systemic inflammatory mediator, procalcitonin (PCT) is one of the new inflammatory markers which have been studied recently. Compared with other biological markers, PCT has higher sensitivity and specificity, and can be more effective to distinguish bacterial infection from other inflammatory processes. PCT is not only a good indicator screening for infectious diseases, because of serum PCT having different concentrations in viral infection, bacterial infection (including Gram-positive bacteria and Gram-negative bacteria), fungal infection or other atypical pathogens infection, it is also effective index that can identificate different pathogenic bacteria infection. The initial serum concentration of PCT has some guiding significance for antibiotic therapy, and in the whole course of treatment, it is important to monitor and manage PCT for evaluating if continuing or discontinuing antibiotics. Moreover, the dynamic changes of PCT are of great significance in evaluating the severity and prognosis of infection, and judging the treatment effectiveness. At the same time, PCT-guided antibiotic treatment can reduce the use of antibiotics, shorten the hospitalization time of patients and reduce the hospitalization costs, thereby reducing the incidence of antibiotic resistance, social cost and increasing social benefit in the whole. Although there were many studies about PCT in different types, different experimental design methods and that had selective biases, the cut-off values or threshold of PCT is difficult to define in identification of infection types, assessment of disease severity and prognosis. Up to date, evidence of very low to moderate quality, with insufficient sample power per outcome, does not clearly support the use of procalcitonin-guided antimicrobial therapy to minimize mortality, clinical severity,reinfection or duration of antimicrobial therapy of patients. It still needs further study.This artical reviewed the clinical application and research progress of procalcitonin.