Biomarkers in lower respiratory tract infections
Biomarkers in lower respiratory tract infections
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DOI：
10.1016/j.pupt.2010.04.007
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发表时间：
2010-12-01
影响因子：
3.2
通讯作者：
Piffer, Federico
中科院分区：
文献类型：
--
作者：
Blasi, Francesco;Stolz, Daiana;Piffer, Federico
本综述旨在为医生提供生物标志物的潜力概述，以补充现有的临床严重程度评分，并结合临床参数改善下呼吸道感染（LRTIs）的诊断、风险分层和管理。生物标志物在诊断下呼吸道感染中的作用尚不清楚。然而，当使用高敏c反应蛋白（CRP）和降钙素原（PCT）时，肺炎诊断的特异性很高。PCT、CRP，尤其是前房利钠肽（MR-proANP）、前血管加压素（CT-proAVP）和前肾上腺髓质素（proADM）水平可以可靠地预测下呼吸道感染的死亡率。这些标记物并没有显著提高严重程度评分的预测值，这证实了生物标记物是为了补充而不是取代临床医生的判断和经过验证的严重程度评分。生物标志物，特别是PCT，是肺炎和慢性阻塞性肺疾病（COPD）加重期抗生素治疗持续时间指标的有用工具。即使需要更多的数据来充分认识生物标志物在LRTIs管理中的作用，也有新的证据表明生物标志物有可能改善LRTIs的日常临床管理。(C) 2010 Elsevier Ltd.版权所有。
This review aims to provide physicians with an overview of the potential of biomarkers to complement existing clinical severity scores and in conjunction with clinical parameters to improve the diagnosis, risk-stratification and management of lower respiratory tract infections (LRTIs).The usefulness of biomarkers for diagnosing LRTIs is still unclear. However, the specificity of pneumonia diagnosis is high when high sensitivity C-reactive protein (CRP) and procalcitonin (PCT) are used.PCT, CRP and particularly pro-atrial natriuretic peptide (MR-proANP), pro-vasopressin (CT-proAVP) and proadrenomedullin (proADM) levels can reliably predict LRTIs mortality. These markers do not significantly improve the severity scores predictive values, confirming that biomarkers are meant to complement, rather than supersede, clinician's judgment and validated severity scores.Biomarkers, and particularly PCT, are useful tools as antibiotic treatment duration indicators both in pneumonia and exacerbations of chronic obstructive pulmonary disease (COPD).Even if more data are required to fully appreciate the role of biomarkers in LRTIs management, there is emerging evidence that biomarkers have the potential to improve the daily clinical management of LRTIs. (C) 2010 Elsevier Ltd. All rights reserved.