Chenevier-Gobeaux Camille, Borderie Didier, Weiss Nicolas, Mallet-Coste Thomas, Claessens Yann-Erick
Service de Diagnostic Biologique Automatisé, Hôpital Cochin (Hôpitaux Universitaires Paris Centre, HUPC), Assistance Publique des Hôpitaux de Paris (AP-HP), 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France.
Service de Diagnostic Biologique Automatisé, Hôpital Cochin (Hôpitaux Universitaires Paris Centre, HUPC), Assistance Publique des Hôpitaux de Paris (AP-HP), 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France; UMR 1124 Pharmacologie, Toxicologie et Signalisation Cellulaire, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Clin Chim Acta. 2015 Oct 23;450:97-103. doi: 10.1016/j.cca.2015.06.026. Epub 2015 Jul 9.
Innate immunity is the first barrier to fight off bacteria, and partly relies on the engagement of the membrane coreceptor CD14. A product of cleavage of CD14, the soluble subtype of CD14 (sCD14-ST) or presepsin, is released in circulation after activation of defense mechanisms. Presepsin can be detected by biochemical methods and therefore appears as an emergent biomarker of infection. Here we present the rationale for presepsin development and recent data supporting its use at bedside. Presepsin may be worthwhile for early diagnosis and prognostic assessment of patients with systemic infections. This biomarker shows high specificity, and results from experimental and clinical studies are reinforcing the proof of concept. Performances place presepsin at the level of PCT who is used as a comparator. Biomarkers of infection are futile to diagnose infection with direct access to bacteria (as urinary tract infection, meningitis), but their use can be advocated to ascertain unclear diagnosis. Future developments of presepsin will probably use clinical models with a Bayesian approach to ascertain the additional value of the biomarker at bedside.
固有免疫是抵御细菌的第一道防线，部分依赖于膜共受体CD14的参与。CD14的裂解产物，即可溶性CD14亚型（sCD14-ST）或前降钙素原，在防御机制激活后释放入循环系统。前降钙素原可通过生化方法检测，因此成为一种新兴的感染生物标志物。在此，我们阐述前降钙素原发展的基本原理以及支持其在床边应用的最新数据。前降钙素原对于全身感染患者的早期诊断和预后评估可能具有重要价值。该生物标志物具有高度特异性，实验和临床研究结果正在强化这一概念验证。其性能使前降钙素原达到了用作对照的降钙素原（PCT）的水平。感染生物标志物对于直接检测到细菌的感染（如尿路感染、脑膜炎）诊断并无帮助，但其应用有助于明确诊断不明确的情况。前降钙素原未来的发展可能会采用贝叶斯方法的临床模型，以确定该生物标志物在床边的附加价值。
