Elevated procalcitonin and C-reactive protein as potential biomarkers of sepsis in a subpopulation of thrombotic microangiopathy patients.
Elevated procalcitonin and C-reactive protein as potential biomarkers of sepsis in a subpopulation of thrombotic microangiopathy patients.
复制标题
降钙素原和 C 反应蛋白升高是血栓性微血管病患者亚群脓毒症的潜在生物标志物。
DOI：
10.1002/jca.20205
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发表时间：
2009
影响因子：
1.5
通讯作者：
Raife,ThomasJ
中科院分区：
文献类型：
--
作者：
Erickson,YasukoO;Samia,NoelleI;Bedell,Bruce;Friedman,KennethD;Atkinson,BonnieS;Raife,ThomasJ
血栓性微血管病(TMA)是一组与多种致病因素相关的微血管血栓形成综合征。ADAMTS13活性不足是TMA患者亚群的致病因素，这为血浆置换治疗提供了强有力的理论基础。然而，ADAMTS13活性正常的TMA患者亚群仍然是一个不同类型的患者组，其中适当的治疗方法尚未得到很好的理解。除了常见形式的TMA血栓性血小板减少性紫癜和溶血性尿毒症综合征外，TMA的鉴别诊断可能包括败血症、自身免疫性疾病和弥散性血管内凝血。TMA的最佳治疗依赖于及时认识可治疗的致病因素。我们假设脓毒症是TMA患者亚群中一种快速可识别的致病因素。为了验证这一假设，我们在61名接受血浆置换治疗的TMA患者的治疗前血浆样本库中，回顾性地测量了脓毒症C反应蛋白(CRP)和降钙素原(PCT)的快速生物标志物。分析了31例ADAMTS13严重缺陷患者和30例ADAMTS13正常患者的水平。ADAMTS13严重缺乏的31例患者无一例PCT升高。然而，30例非ADAMTS13缺陷患者样本中有11例(37%)PCT呈强阳性。这些患者样本的C反应蛋白中值水平也是PCT正常患者的10倍。我们得出结论，快速检测可能有助于确定部分TMA患者的脓毒症。J·克莱恩。《分离》，2009年。©2009威利-利斯，Inc.
Thrombotic microangiopathy (TMA) comprises a group of microvascular thrombosis syndromes associated with multiple pathogenic factors. Deficient activity of ADAMTS13 is a pathogenic factor in a subset of TMA patients that provides a strong rationale for plasma exchange treatment. However, the subset of TMA patients with normal ADAMTS13 activity remains a heterogeneous group of patients in which the appropriate treatment is not well understood. In addition to the common forms of TMA thrombotic thrombocytopenic purpura and the hemolytic uremic syndrome, the differential diagnosis of TMA may include sepsis, autoimmune disorders, and disseminated intravascular coagulation. Optimal treatment of TMA depends on timely recognition of treatable pathogenic factors. We hypothesized that sepsis is a rapidly identifiable pathogenic factor in a subset of TMA patients. To test this hypothesis, we retrospectively measured the rapid biomarkers of sepsis C‐reactive protein (CRP) and procalcitonin (PCT), in a repository of pretreatment plasma samples from 61 TMA patients treated with plasma exchange. Levels were analyzed in 31 severely ADAMTS13‐deficient and 30 ADAMTS13‐normal patients. None of the 31 patients with severe deficiency of ADAMTS13 had elevated PCT. However, 11 of 30 (37%) non‐ADAMTS13‐deficient patient samples were strongly positive for PCT. These patient samples also had a >10‐fold higher median CRP level than patients with normal PCT. We conclude that rapid assays may help identify sepsis in a subset of TMA patients. J. Clin. Apheresis, 2009. © 2009 Wiley‐Liss, Inc.