Montagnana Martina, Lippi Giuseppe, Tessitore Nicola, Salvagno Gian Luca, Danese Elisa, Targher Giovanni, Lupo Antonio, Guidi Gian Cesare
Sezione di Chimica Clinica, Dipartimento di Scienze Morfologico-Biomediche, Ospedale Policlinico G.B. Rossi, Piazzale Scuro, 10, Verona 37134, Italy.
Scand J Clin Lab Invest. 2009;69(6):703-7. doi: 10.3109/00365510902993663.
Infections account for considerable morbidity and mortality in patients with chronic renal failure undergoing hemodialysis (HD). Diagnosis of infection in HD patients is challenging because the most used laboratory parameters may be increased even in the absence of infection. In this setting, procalcitonin (PCT) could be useful for detection of systemic bacterial infections.
We measured high sensitivity C Reactive Protein (hsCRP) and PCT serum levels before and immediately after dialysis in 44 HD patients (22 treated with high- and 22 with low-flux membranes), without history of infections.
Patients on HD by high-flux membranes, but not by low-flux membranes, displayed mean PCT values significantly decreased after dialysis (high-flux: 0.50 vs. 0.26 ng/mL, p=0.005; low-flux: 0.41 vs. 0.42 ng/mL, p=0.863). HsCRP levels were unchanged. HsCRP correlated with PCT values both before and after HD only in patients on HD by low-flux membranes (r=0.51 and 0.47 before and after HD respectively; p<0.05).
Although PCT is considered a sensitive and specific diagnostic and prognostic marker of systemic bacterial infection, we suggest that specific reference ranges might be developed in patient with impaired renal function, also showing that and its clinical usefulness might be limited in patients undergoing HD with high-flux membranes.
感染是接受血液透析（HD）的慢性肾衰竭患者发病和死亡的重要原因。HD患者感染的诊断具有挑战性，因为即使在没有感染的情况下，最常用的实验室参数也可能升高。在这种情况下，降钙素原（PCT）可能有助于检测全身性细菌感染。
我们测量了44例无感染史的HD患者（22例使用高通量膜治疗，22例使用低通量膜治疗）透析前及透析后即刻的高敏C反应蛋白（hsCRP）和PCT血清水平。
使用高通量膜进行HD的患者，而非低通量膜患者，透析后平均PCT值显著降低（高通量：0.50 vs. 0.26 ng/mL，p = 0.005；低通量：0.41 vs. 0.42 ng/mL，p = 0.863）。hsCRP水平无变化。仅在使用低通量膜进行HD的患者中，HD前后hsCRP与PCT值相关（HD前和后r分别为0.51和0.47；p < 0.05）。
尽管PCT被认为是全身性细菌感染的敏感且特异的诊断和预后标志物，但我们建议可能需要为肾功能受损的患者制定特定的参考范围，同时也表明其在使用高通量膜进行HD的患者中的临床应用可能有限。
