Bertsch T, Richter A, Hofheinz H, Böhm C, Hartel M, Aufenanger J
Institut für Klinische Chemie, Klinikum Mannheim, Universität Heidelberg, Germany.
Langenbecks Arch Chir. 1997;382(6):367-72. doi: 10.1007/s004230050081.
Procalcitonin is a protein which is found in elevated concentrations in the blood circulation during systemic bacterial, fungal or protozoal infection. In contrast to classical acute-phase proteins like C-reactive protein or interleukin-6, it is not elevated after operative trauma. In this paper we present current opinions on the assumed induction mechanisms of the protein by cytokines and endotoxin. Furthermore, the clinical value for early detection of systemic infections in abdominal and transplantation surgery is demonstrated by examples from the literature. Our investigation shows that eight patients with necrotizing pancreatitis had a PCT mean value of 6.9 ng/ml on the day of admission. Seven patients with edematous pancreatitis had only a PCT mean value of 0.69 ng/ml. Despite these differences in the mean values, a significant difference between the normal value and the mean value of the group with necrotizing pancreatitis or edematous pancreatitis was not observed due to the wide range of PCT levels in the group of patients with necrotizing pancreatitis. The fact that only a few of the patients had a superinfected necrosis with systemic evasion of bacterias or their toxins may be the reason for this wide range. We suggest that a discrimination between superinfected necrotizing or sterile pancreatitis and edematous pancreatitis by PCT could be possible but more extensive studies with microbiological examination of the necrotic material are required to recognize the subgroups and to establish the real diagnostic efficiency of PCT in clinical practice, especially in the prediction of the outcome of acute pancreatitis.
降钙素原是一种蛋白质，在全身性细菌、真菌或原生动物感染期间，其在血液循环中的浓度会升高。与C反应蛋白或白细胞介素-6等经典急性期蛋白不同，它在手术创伤后不会升高。在本文中，我们阐述了关于细胞因子和内毒素对该蛋白假定诱导机制的当前观点。此外，通过文献中的实例展示了降钙素原在腹部手术和移植手术中早期检测全身性感染的临床价值。我们的研究表明，8例坏死性胰腺炎患者入院当天的降钙素原平均值为6.9 ng/ml。7例水肿性胰腺炎患者的降钙素原平均值仅为0.69 ng/ml。尽管平均值存在这些差异，但由于坏死性胰腺炎患者组中降钙素原水平范围较宽，未观察到坏死性胰腺炎组或水肿性胰腺炎组的正常价值与平均值之间存在显著差异。少数患者出现伴有细菌或其毒素全身播散的感染性坏死，可能是造成这种较宽范围的原因。我们认为，通过降钙素原区分感染性坏死性或无菌性胰腺炎与水肿性胰腺炎是有可能的，但需要对坏死物质进行微生物学检查的更广泛研究，以识别亚组并确定降钙素原在临床实践中的实际诊断效率，尤其是在预测急性胰腺炎的结局方面。
