Plasma procalcitonin in sepsis and organ failure.
Plasma procalcitonin in sepsis and organ failure.
复制标题
脓毒症和器官衰竭中的血浆降钙素原。
DOI：
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发表时间：
2001
期刊：
影响因子：
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通讯作者：
Noboru Kato
中科院分区：
文献类型：
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作者：
H. Yukioka;G. Yoshida;S. Kurita;Noboru Kato
介绍
由于主张使用降钙素原（PCT）作为细菌感染的标志物，本研究旨在确定血浆PCT在早期诊断和区分非感染性全身炎症反应综合征（SIRS）患者与脓毒症患者中的有用性，以及血浆PCT水平与器官衰竭严重程度之间的关系。
材料和方法
本研究纳入了35例非脓毒性SIRS（n = 16）、脓毒症（n = 7）或脓毒性休克（n = 12）患者。测定PCT和C反应蛋白（CRP）水平，并计算脓毒症相关器官衰竭评估（SOFA）评分。采用免疫发光法测定血浆PCT。
结果
血浆PCT水平的中位数（最小值，最大值）在非脓毒性SIRS中为0.6（0.1，3.4）ng/mL，在脓毒性中为5.4（0.9，47.7）ng/mL，在脓毒性休克中为73.4（9.6，824.1）ng/mL，三组间血浆PCT水平存在显著差异。非脓毒症SIRS患者的中位（最小值，最大值）CRP水平为13.8（0.3，48.8）mg/dL，脓毒症患者为23.3（1.4，26.6）mg/dL，脓毒症休克患者为17.4（2.2，34.1）mg/dL，三组之间无显著差异。血浆PCT水平与SOFA评分有良好的相关性（rs = 0.766，P < 0.0001），而CRP水平与SOFA评分无相关性。
结论
炎症性疾病和感染会导致CRP升高，因此在严重SIRS患者中，CRP不是感染的良好指标。另一方面，PCT是严重SIRS患者脓毒症和器官衰竭严重程度的良好指标，因为PCT水平与脓毒症和SOFA评分相关。PCT水平可用于诊断脓毒症，并可作为SIRS患者器官衰竭严重程度的指标。
INTRODUCTION
Because the use of procalcitonin (PCT) as a marker of bacterial infection has been advocated, this study was carried out to determine the usefulness of plasma PCT in the early diagnosis and differentiation of patients with non-infectious systemic inflammatory response syndrome (SIRS) from those with sepsis, and the relationship between plasma PCT level and severity of organ failure.
MATERIALS AND METHODS
Thirty-five patients with non-septic SIRS (n = 16), sepsis (n = 7) or septic shock (n = 12) were included in this study. PCT and C-reactive protein (CRP) levels were measured and sepsis-related organ failure assessment (SOFA) score was calculated for these patients. Plasma PCT was measured by immunoluminometric assay.
RESULTS
The median (minimum, maximum) plasma PCT levels were 0.6 (0.1, 3.4) ng/mL in non-septic SIRS, 5.4 (0.9, 47.7) ng/mL in sepsis and 73.4 (9.6, 824.1) ng/mL in septic shock, and significant differences existed in plasma PCT levels among the three groups. The median (minimum, maximum) CRP levels were 13.8 (0.3, 48.8) mg/dL in non-septic SIRS, 23.3 (1.4, 26.6) mg/dL in sepsis and 17.4 (2.2, 34.1) mg/dL in septic shock, without significant differences among the three groups. A good correlation was found between plasma PCT level and SOFA score (rs = 0.766, P < 0.0001), although no correlation was found between CRP level and SOFA score.
CONCLUSIONS
CRP is increased by inflammatory disease as well as infection and is therefore not a good indicator of infection in patients with severe SIRS. On the other hand, PCT is a good indicator of severity of sepsis and organ failure in patients with severe SIRS since PCT levels correlated with sepsis and SOFA scores. PCT level is useful for diagnosis of sepsis and as an indicator of severity of organ failure in patients with SIRS.