• 復(fù)旦大學(xué)附屬中山醫(yī)院呼吸科( 上海 200040);

對臨床上一個擬診肺部感染的患者, 臨床醫(yī)生通常依據(jù)癥狀、白細(xì)胞總數(shù)和分類計數(shù), 以及胸部影像學(xué)檢查作出診斷, 以期盡早開始治療, 此時抗生素的選擇只能是經(jīng)驗(yàn)性的, 等治療后隨訪觀察胸片上的浸潤影有無吸收才能確定此浸潤影是否為感染性的。換言之, 臨床癥狀及影像學(xué)檢查對于鑒別感染性和非感染性肺部疾病缺乏特異性, 而肺部感染的診斷多屬于回顧性的。
目前, 有一些生物標(biāo)志物用于幫助判斷肺部浸潤影為感染性或非感染性, 主要包括C 反應(yīng)蛋白( C-reactive protein,CRP) 、降鈣素原( procalcitonin, PCT) 和可溶性髓樣細(xì)胞觸發(fā)受體1( soluble triggering receptor expressed onmyeloid cells-1,sTREM-1) 等。

引用本文： 瞿介明,Hanssa Summah. 血清生物標(biāo)志物鑒別肺部感染性及非感染性疾病的價值評估. 中國呼吸與危重監(jiān)護(hù)雜志, 2009, 09(6): 517-518. doi: 復(fù)制

1. Flanders SA, Stein J, Shochat G, et al. Performance of a bedside C-reactive protein test in the diagnosis of community-acquired pneumonia in adults with acute cough. Am J Med, 2004, 116: 529- 535.
2. Almirall J, Bol í bar I, Toran P, et al. Contribution of C-reactive protein to the diagnosis and assessment of severity of communityacquired pneumonia. Chest, 2004, 125: 1192-1195.
3. Smith RP, Lipworth BJ. C-reactive protein in simple communityacquired pneumonia. Chest, 1995, 107: 1028-1031.
4. Offidani M, Corvatta L, Malerba L, et al. Diagnostic value of Creactive protein in discriminating fungal from nonfungal pulmonary infiltrates in patients with hematologic malignancies. Support Care Cancer, 2006, 14: 874-877.
5. P ó voa P, Coelho L, Almeida E, et al. C-reactive protein as a marker of infection in critically ill patients. Clin Microbiol Infect,2005, 11: 101-108.
6. Chan YL, Tseng CP, Tsay PK, et al. Procalcitonin as a marker of bacterial infection in the emergency department: an observational study. Crit Care, 2004, 8: R12-R20.
7. Pelosi P, Barassi A, Severgnini P, et al. Prognostic role of clinical and laboratory criteria to identify early ventilator-associated pneumonia in brain injury. Chest, 2008, 134: 101-108.
8. Gendrel D, Raymon J, Moulin F, et al. Procalcitonin in community-acquired pneumonia: comparison with interleukin-6, Creactive protein, and interferon-alpha for diagnosis of bacterial vs.viral infections in children. Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother, 1999 , 39 :237.
9. Masi á M, Guti é rrez F, Shum C, et al. Usefulness of procalcitonin levels in community-acquired pneumonia according to the patients outcome research teampneumonia severity index. Chest, 2005, 128 :2223-2229.
10. Shehabi Y, Seppelt I. Pro /Con debate: Is procalcitonin useful for guiding antibiotic decision making in critically ill patients? Critical Care, 2008, 12: 211.
11. Schuetz P, Christ-Crain M, M ü ller B. Procalcitonin and other biomarker to improve assessment and antibiotic stewardship infections-hope for hype? Swiss Med Wkly, 2009, 139: 318-326.
12. Hedlund J, Hansson LO. Procalcitonin and C-reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis. Infection, 2000, 28 : 68 -73.
13. Holm A, Pedersen S, Nexoe J, et al. Procalcitonin versus Creactive protein for predicting pneumonia in adults with lower respiratory tract infection in primary care. Br J Gen Pract, 2007,57: 555-560.
14. Schleicher GK, Herbert V, Brink A, et al. Procalcitonin and Creactive protein levels in HIV-positive subjects with tuberculosis and pneumonia. Eur Respir J, 2005, 25: 688-692.
15. Tejera A, Santolaria F, Diez ML, et al . Prognosis of community acquired pneumonia ( CAP) : value of triggering receptor expressed on myeloid cells-1 ( TREM-1 ) and other mediators of the inflammatory response. Cytokine, 2007, 38: 117-123.
16. Chao WC, Wang CH, Chan MC, et al. Predictive value of serial measurements of sTREM-1 in the treatment response of patients with community-acquired pneumonia. J Formos Med Assoc, 2007 , 106 : 187-195.
17. Huh JW, LimCM, Koh Y, et al. Diagnostic utility of the soluble triggering receptor expressed on myeloid cells-1 in bronchoalveolar lavage fluid from patients with bilateral lung infiltrates. Critical Care, 2008, 12: R6.
18. Determann RM, Millo JL, Gibot S, et al. Serial changes in soluble triggering receptor expressed on myeloid cells in the lung during development of ventilator-associated pneumonia. Intensive Care Med, 2005, 31: 1495-1500.
19. Christ-Crain M, Schuetz P, M ü ller B, et al. Biomarkers in the management of pneumonia. Expert Rev Respir Med, 2008, 2: 565-572.
  1. 1. Flanders SA, Stein J, Shochat G, et al. Performance of a bedside C-reactive protein test in the diagnosis of community-acquired pneumonia in adults with acute cough. Am J Med, 2004, 116: 529- 535.
  2. 2. Almirall J, Bol í bar I, Toran P, et al. Contribution of C-reactive protein to the diagnosis and assessment of severity of communityacquired pneumonia. Chest, 2004, 125: 1192-1195.
  3. 3. Smith RP, Lipworth BJ. C-reactive protein in simple communityacquired pneumonia. Chest, 1995, 107: 1028-1031.
  4. 4. Offidani M, Corvatta L, Malerba L, et al. Diagnostic value of Creactive protein in discriminating fungal from nonfungal pulmonary infiltrates in patients with hematologic malignancies. Support Care Cancer, 2006, 14: 874-877.
  5. 5. P ó voa P, Coelho L, Almeida E, et al. C-reactive protein as a marker of infection in critically ill patients. Clin Microbiol Infect,2005, 11: 101-108.
  6. 6. Chan YL, Tseng CP, Tsay PK, et al. Procalcitonin as a marker of bacterial infection in the emergency department: an observational study. Crit Care, 2004, 8: R12-R20.
  7. 7. Pelosi P, Barassi A, Severgnini P, et al. Prognostic role of clinical and laboratory criteria to identify early ventilator-associated pneumonia in brain injury. Chest, 2008, 134: 101-108.
  8. 8. Gendrel D, Raymon J, Moulin F, et al. Procalcitonin in community-acquired pneumonia: comparison with interleukin-6, Creactive protein, and interferon-alpha for diagnosis of bacterial vs.viral infections in children. Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother, 1999 , 39 :237.
  9. 9. Masi á M, Guti é rrez F, Shum C, et al. Usefulness of procalcitonin levels in community-acquired pneumonia according to the patients outcome research teampneumonia severity index. Chest, 2005, 128 :2223-2229.
  10. 10. Shehabi Y, Seppelt I. Pro /Con debate: Is procalcitonin useful for guiding antibiotic decision making in critically ill patients? Critical Care, 2008, 12: 211.
  11. 11. Schuetz P, Christ-Crain M, M ü ller B. Procalcitonin and other biomarker to improve assessment and antibiotic stewardship infections-hope for hype? Swiss Med Wkly, 2009, 139: 318-326.
  12. 12. Hedlund J, Hansson LO. Procalcitonin and C-reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis. Infection, 2000, 28 : 68 -73.
  13. 13. Holm A, Pedersen S, Nexoe J, et al. Procalcitonin versus Creactive protein for predicting pneumonia in adults with lower respiratory tract infection in primary care. Br J Gen Pract, 2007,57: 555-560.
  14. 14. Schleicher GK, Herbert V, Brink A, et al. Procalcitonin and Creactive protein levels in HIV-positive subjects with tuberculosis and pneumonia. Eur Respir J, 2005, 25: 688-692.
  15. 15. Tejera A, Santolaria F, Diez ML, et al . Prognosis of community acquired pneumonia ( CAP) : value of triggering receptor expressed on myeloid cells-1 ( TREM-1 ) and other mediators of the inflammatory response. Cytokine, 2007, 38: 117-123.
  16. 16. Chao WC, Wang CH, Chan MC, et al. Predictive value of serial measurements of sTREM-1 in the treatment response of patients with community-acquired pneumonia. J Formos Med Assoc, 2007 , 106 : 187-195.
  17. 17. Huh JW, LimCM, Koh Y, et al. Diagnostic utility of the soluble triggering receptor expressed on myeloid cells-1 in bronchoalveolar lavage fluid from patients with bilateral lung infiltrates. Critical Care, 2008, 12: R6.
  18. 18. Determann RM, Millo JL, Gibot S, et al. Serial changes in soluble triggering receptor expressed on myeloid cells in the lung during development of ventilator-associated pneumonia. Intensive Care Med, 2005, 31: 1495-1500.
  19. 19. Christ-Crain M, Schuetz P, M ü ller B, et al. Biomarkers in the management of pneumonia. Expert Rev Respir Med, 2008, 2: 565-572.

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