Pundiche M, Sârbu V, Unc O D, Grasa C, Martinescu A, Bădărău V, Durbală I, Sapte E, Pasăre R, Voineagu L, Iordache I, Vâncă A, Adam A
Facultatea de Medicină Generală, Universitatea Ovidius, Constanţa, Romania.
Chirurgia (Bucur). 2012 Jan-Feb;107(1):71-8.
Based on the need for rigorous monitoring of antibiotic and a proper assessment of patients with sepsis, procalcitonina as biological marker appears to have significant value, being proposed for both detection and for evaluation of bacterial infection and antibiotic management.
We conducted a prospective study on a group of 73 patients admitted in Surgical Clinic II you SCJU Constanta between 2010-2011, which is included in the study criteria ACCP/SCCM Consensus Conference in 1992. We have made determinations of the PCT, in dynamic, since the admission of patients, with imunocromatographic method, monitoring the antibiotics on the studied group depending on cut-off fluctuations and PCT.
The level of procalcitonin reflect the degree of systemic inflammatory response. PCT dosages were performed in 17 patients without inflammation/infection in 21 patients with local infections, 20 with systemic infection (sepsis), 7 with severe sepsis and septic shock 3/MSOF. In the studied group we excluded 5 patients with associated pathology (on the first day after a major trauma, major surgery, burns, treatment with drugs that stimulate the release of pro-inflammatory cytokines, small cell lung cancer, medullary thyroid carcinoma) in that the PCT was in the absence of an inflammatory process cresct/infectious manifesto. Starting, monitoring and stopping the antibiotic was carried out based on PCT levels. The dosage of procalcitonin (PCT) revealed significantly elevated values in patients with severe sepsis and septic shock/MSOF. PCT was significantly lower in patients with sepsis compared with those with septic shock, and the difference between PCT values in patients with sepsis and severe sepsis was the limit of statistical significance. PCT values were not predictive of death, however.
In conclusion, dynamic measurement of PCT may be a predictor for life-threatening infections with antibiotics that can monitor and direct the time and efficiency. The value of PCT as a guide of antibacterial therapy which can reduce mortality and morbidity in surgical septic patients remains to be fully evaluated by future studies, but we can say that the determination of this biomarker could be introduced in the dynamically protocol of tracking the clinical course of septic patients.
基于严格监测抗生素以及正确评估脓毒症患者的需求，降钙素原作为一种生物标志物似乎具有重要价值，被提议用于细菌感染的检测、评估以及抗生素管理。
我们对2010年至2011年间在康斯坦察SCJU第二外科诊所收治的73例患者进行了一项前瞻性研究，这些患者符合1992年ACCP/SCCM共识会议的研究标准。自患者入院起，我们采用免疫层析法动态测定降钙素原（PCT），并根据PCT的波动情况和临界值对研究组患者使用的抗生素进行监测。
降钙素原水平反映了全身炎症反应的程度。对17例无炎症/感染的患者、21例局部感染患者、20例全身感染（脓毒症）患者、7例严重脓毒症和感染性休克患者以及3例多器官功能障碍综合征（MSOF）患者进行了PCT检测。在研究组中，我们排除了5例伴有相关病理情况的患者（严重创伤、大手术后第一天、烧伤、使用刺激促炎细胞因子释放的药物治疗、小细胞肺癌、甲状腺髓样癌），因为这些患者在没有炎症过程/感染表现的情况下PCT升高。抗生素的起始、监测和停用均基于PCT水平。降钙素原（PCT）检测显示，严重脓毒症和感染性休克/MSOF患者的值显著升高。脓毒症患者的PCT明显低于感染性休克患者，脓毒症患者与严重脓毒症患者的PCT值差异具有统计学意义的临界值。然而，PCT值并不能预测死亡。
总之，动态测定PCT可能是危及生命感染使用抗生素的一个预测指标，可监测并指导用药时间和效率。PCT作为抗菌治疗指南以降低外科脓毒症患者死亡率和发病率的价值仍有待未来研究充分评估，但我们可以说，这种生物标志物的测定可引入脓毒症患者临床病程的动态跟踪方案中。
