Sprong Tom, Peri Giuseppe, Neeleman Chris, Mantovani Alberto, Signorini Stefano, van der Meer Jos W M, van Deuren Marcel
Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
Shock. 2009 Jan;31(1):28-32. doi: 10.1097/SHK.0b013e31817fd543.
The long pentraxin 3 (PTX3) is an important element of the innate immune system and has potential as a diagnostic tool in inflammatory conditions. We studied PTX3 in patients admitted to an intensive care unit with severe meningococcal disease and compared it with the short pentraxin C-reactive protein (CRP). Twenty-six patients with meningococcal disease were studied, 17 patients presented with meningococcal septic shock (shock group), and 9 patients presented with meningococcal meningitis or bacteremia (no-shock group). Pentraxin 3 and CRP were measured by enzyme-linked immunosorbent assay. High plasma concentrations of PTX3 (median, 579 microg/L) were seen at admission in patients with meningococcal disease. Concentrations were significantly higher in patients with shock compared with patients without shock (medians, 801 and 256 microg/L, respectively; P = 0.006). In contrast, CRP at admission was lower in the shock group as compared with the no-shock group (medians, 58 and 165 mg/L, respectively; P = 0.008). High PTX3 and low CRP concentration at admission discriminated between presence and absence of shock (area under the receiver operating characteristic curve, 0.85; P = 0.007 for PTX3 and area under the receiver operating characteristic curve, 0.84; P = 0.01 for CRP). PTX3 did not correlate with disease severity (pediatric risk of mortality) and days spent in the intensive care unit. PTX3 at admission and PTX3 peak concentration both showed a negative correlation with plasma fibrinogen concentrations. C-reactive protein concentration at admission correlated negatively with disease severity. In conclusion, PTX3 was an early indicator of shock in patients with severe meningococcal disease that followed a pattern of induction distinct from CRP.
长五聚蛋白3（PTX3）是先天性免疫系统的重要组成部分，在炎症性疾病中具有作为诊断工具的潜力。我们对入住重症监护病房的重症脑膜炎球菌病患者的PTX3进行了研究，并将其与短五聚蛋白C反应蛋白（CRP）进行比较。研究了26例脑膜炎球菌病患者，其中17例出现脑膜炎球菌性感染性休克（休克组），9例出现脑膜炎球菌性脑膜炎或菌血症（无休克组）。采用酶联免疫吸附测定法检测五聚蛋白3和CRP。脑膜炎球菌病患者入院时血浆PTX3浓度较高（中位数为579μg/L）。与无休克患者相比，休克患者的浓度显著更高（中位数分别为801和256μg/L；P = 0.006）。相比之下，休克组入院时的CRP低于无休克组（中位数分别为58和165mg/L；P = 0.008）。入院时PTX3浓度高和CRP浓度低可区分休克的有无（受试者工作特征曲线下面积，PTX3为0.85；P = 0.007，CRP为0.84；P = 0.01）。PTX3与疾病严重程度（儿童死亡风险）及在重症监护病房的天数无关。入院时的PTX3和PTX3峰值浓度均与血浆纤维蛋白原浓度呈负相关。入院时C反应蛋白浓度与疾病严重程度呈负相关。总之，PTX3是重症脑膜炎球菌病患者休克的早期指标，其诱导模式与CRP不同。
