Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan.
Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan.
Am J Med Sci. 2012 Feb;343(2):136-140. doi: 10.1097/MAJ.0b013e31822846db.
High serum procalcitonin (PCT) levels (≥0.5 ng/mL) commonly occur with systemic bacterial and fungal infections. Although several studies suggested that measuring serum PCT levels may serve as a useful marker to distinguish between active antineutrophil cytoplasmic antibodies (ANCA)-associated diseases and invasive infections, there is no information on PCT in myeloperoxidase (MPO)-ANCA-associated glomerulonephritis.
The authors measured serum PCT concentrations before initiation of immunosuppressive therapy in 67 patients with biopsy-proven MPO-ANCA-associated glomerulonephritis. The authors compared complications and clinicopathological parameters between patients with serum PCT levels of <0.5 ng/mL (group A: 58 patients) and ≥0.5 ng/mL (group B: 9 patients).
All 58 patients in group A did not show any clinical sign of systemic infection. On the other hand, 3 of 9 patients in group B had bacterial or fungal infections of the respiratory or urinary tact. One patient had a history of chronic urinary tract infection. In the remaining 5 patients in group B, there were 3 patients with concurrent malignancies and 1 postoperative patient with malignancy. Another in group B had a long history of interstitial pneumonia of unknown origin and severe renal insufficiency. Serum levels of C-reactive protein and creatinine were significantly higher in group B than in group A.
In patients with MPO-ANCA-associated glomerulonephritis, serum PCT levels of ≥0.5 ng/mL are recommended as cutoff for consideration of bacterial and fungal infections. Elevated serum PCT levels could also be observed in some patients with severe injury of the kidneys and/or lungs in the absence of infection.
高血清降钙素原（PCT）水平（≥0.5ng/ml）通常与全身细菌和真菌感染有关。虽然几项研究表明，测量血清 PCT 水平可能作为一种有用的标志物来区分活性抗中性粒细胞胞质抗体（ANCA）相关性疾病和侵袭性感染，但在髓过氧化物酶（MPO）-ANCA 相关性肾小球肾炎中尚无关于 PCT 的信息。
作者在 67 例经活检证实的 MPO-ANCA 相关性肾小球肾炎患者开始免疫抑制治疗前测量了血清 PCT 浓度。作者比较了血清 PCT 浓度<0.5ng/ml（A 组：58 例）和≥0.5ng/ml（B 组：9 例）患者的并发症和临床病理参数。
A 组的 58 例患者均未出现任何全身感染的临床征象。另一方面，B 组的 9 例患者中有 3 例患有呼吸道或泌尿道的细菌或真菌感染。1 例患者有慢性尿路感染病史。在 B 组的其余 5 例患者中，有 3 例合并恶性肿瘤，1 例术后患者合并恶性肿瘤。另 1 例 B 组患者患有原因不明的间质性肺炎和严重肾功能不全。B 组患者的血清 C 反应蛋白和肌酐水平明显高于 A 组。
在 MPO-ANCA 相关性肾小球肾炎患者中，血清 PCT 水平≥0.5ng/ml 作为考虑细菌和真菌感染的临界值。在一些肾脏和/或肺部严重损伤而无感染的患者中，也可观察到血清 PCT 水平升高。
