Póvoa Pedro
Faculty of Medical Sciences, New University of Lisbon, Medical Intensive Care Unit, Department of Medicine, São Francisco Xavier Hospital, Lisbon, Portugal.
Curr Opin Infect Dis. 2008 Apr;21(2):157-62. doi: 10.1097/QCO.0b013e3282f47c32.
This article reviews recent data on the usefulness of serum markers in community-acquired pneumonia and ventilator-associated pneumonia. The focus is on clinical studies, with an emphasis on adult critically ill patients.
Serum markers have demonstrated potential value in early prediction and diagnosis of pneumonia, in monitoring the clinical course and in guiding antibiotic therapy. C-reactive protein appears to perform better in diagnosing infection, because several studies have shown that procalcitonin may remain undetectable in some patients, specifically those with pneumonia. Procalcitonin exhibited a better correlation with clinical severity, however. Furthermore, one report demonstrated the efficacy and safety of procalcitonin-guided antibiotic therapy in community-acquired pneumonia.
Serum markers should only be used as a complementary tool to support the current clinical approach. Use of serum markers, in particular procalcitonin and C-reactive protein, represents a promising strategy in the clinical decision-making process in patients in whom pneumonia is suspected. Specifically, these markers can be used to guide culture sampling and empirical antibiotic prescription, and to monitor the clinical course, adjust the duration of antibiotic therapy and identify nonresponders, in whom an aggressive diagnostic and therapeutic approach may prevent further clinical deterioration.
本文回顾了血清标志物在社区获得性肺炎和呼吸机相关性肺炎中应用的最新数据。重点是临床研究，尤其关注成年重症患者。
血清标志物在肺炎的早期预测和诊断、监测临床病程以及指导抗生素治疗方面已显示出潜在价值。C反应蛋白在诊断感染方面似乎表现更佳，因为多项研究表明，降钙素原在一些患者（特别是肺炎患者）中可能检测不到。然而，降钙素原与临床严重程度的相关性更好。此外，一份报告证明了降钙素原指导下的抗生素治疗在社区获得性肺炎中的有效性和安全性。
血清标志物仅应用作辅助工具，以支持当前的临床方法。使用血清标志物，特别是降钙素原和C反应蛋白，在疑似肺炎患者的临床决策过程中是一种有前景的策略。具体而言，这些标志物可用于指导培养采样和经验性抗生素处方，监测临床病程，调整抗生素治疗时长并识别无反应者，对这些患者采取积极的诊断和治疗方法可防止临床进一步恶化。
