血清降钙素原在细菌性脑膜炎中的价值

doi:10.12092/j.issn.1009-2501.2019.11.017

摘要/Abstract

摘要：

细菌性脑膜炎（BM）是儿童常见的中枢神经系统（CNS）疾病，对患儿健康具有严重威胁，及时对脑炎类型作出诊断并迅速启动治疗至关重要。目前诊断BM的金标准仍为脑脊液检查，但患儿配合度低，提取脑脊液操作难度和损失较大，且脑脊液培养耗时长、检测阳性率低，所以脑脊液检查对BM早期治疗的指导意义有限，存在延误病情的可能。血清降钙素原(S-PCT)对细菌感染早期预测有较高的敏感度和特异度。大量的证据表明S-PCT是评估已知或疑似CNS感染患者的有用工具，可以帮助诊断BM并评估预后。本文对目前关于S-PCT及其对BM的诊断和评估预后的价值等知识进行简要综述。

关键词: 血清降钙素原, 细菌性脑膜炎, 诊断, 预后

Abstract:

Bacterial meningitis (BM) is a common central nervous system disease (CNS) in children, which poses a serious threat to the health of children.Therefore, it is of great importance to timely diagnose the type of encephalitis and promptly start treatment.At present, the gold standard for the diagnosis of BM is still cerebrospinal fluid examination, but the cooperation degree of children is low, the extraction of cerebrospinal fluid is difficult and the loss is large, and the cerebrospinal fluid culture takes a long time and the positive detection rate is low, so the significance of cerebrospinal fluid examination for the early treatment of BM is limited, and there is the possibility of delay of the disease.Serum procalcitonin (S-PCT) has high sensitivity and specificity to early prediction of bacterial infection.A large amount of evidence indicates that S-PCT is a useful tool for evaluating patients with known or suspected CNS infection, which can help diagnose BM and evaluate prognosis.This paper reviewes the current knowledge about S-PCT and its value in diagnosis and prognosis evaluation of BM.

Key words: serum procalcitonin, bacterial meningitis, diagnosis, prognosis

中图分类号:

R515

李文书，董淮富. 血清降钙素原在细菌性脑膜炎中的价值[J]. 中国临床药理学与治疗学, 2019, 24(11): 1315-1320.

LI Wenshu, DONG Huaifu. The value of serum calcitonin in bacterial meningitis[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2019, 24(11): 1315-1320.

参考文献

［1］Srinivasan L, Kilpatrick L, Shah SS, et al. Elevations of novel cytokines in bacterial meningitis in infants［J］. Plos One, 2018, 13(2):e0181449.
［2］Jiang H, Su M, Kui L, et al.Prevalence and antibiotic resistance profiles of cerebrospinal fluid pathogens in children with acute bacterial meningitis in Yunnan province, China, 2012-2015［J］. Plos One, 2017, 12(6):e0180161.
［3］Khalid M,Saleem AF.Concordance of cerebrospinal fluid latex particle agglutination test with CSF and blood culture among children with acute bacterial meningitis［J］.J Pak Med Assoc,2017,67(11):1783-1784.
［4］王志文,刘占利,林争,等.脓毒症血流感染患儿血清C-反应蛋白、降钙素原水平变化及临床诊断分析［J］.中华医院感染学杂志,2017，27(4):919-922.
［5］Bouza E, MartNez-Alarc3N J, Maseda E, et al.Quality of the aetiological diagnosis of ventilator-associated pneumonia in Spain in the opinion of intensive care specialists and microbiologists［J］. Enferm Infecc Microbiol Clin，2017, 35(3):153-164.
［6］Dashti AS, Alizadeh S, Karimi A, et al. Diagnostic value of lactate, procalcitonin, ferritin, serum-C-reactive protein, and other biomarkers in bacterial and viral meningitis: A cross-sectional study［J］. Medicine, 2017, 96(35):e7637.
［7］Velissaris D, Pintea M, Pantzaris N, et al. The role of procalcitonin in the diagnosis of meningitis: a literature review［J］. J Clin Med, 2018, 7(6):148.
［8］吴和弟, 许丽娃, 吉家钗, 等. 2型糖尿病合并冠心病患者血清PCT、hs-CRP及血脂水平与冠状动脉病变的关系分析［J］. 疑难病杂志, 2018,17(10):1094-1098.
［9］中国医药教育协会感染疾病专业委员会. 感染相关生物标志物临床意义解读专家共识［J］.中华结核和呼吸杂志, 2017, 40(4):243-257.
［10］Reshi Z, Nazir M, Wani W, et al.Cerebrospinal fluid procalcitonin as a biomarker of bacterial meningitis in neonates［J］. J Perinatol，2017，37(8):927-931.
［11］Li W, Sun X, Yuan F, et al. Diagnostic accuracy of cerebrospinal fluid procalcitonin in bacterial meningitis patients with empiric antibiotic pretreatment［J］. J Clin Microbiol，2017，55(4):1193-1204.
［12］Choi JJ, Mccarthy MW.Novel applications for serum procalcitonin testing in clinical practice［J］. Expert Rev Mol Diagn, 2018，18(1):27-34.
［13］Trippella G, Galli L, Martino MD.Procalcitonin performance in detecting serious and invasive bacterial infections in children with fever without apparent source a systematic review and meta-analysis［J］. Expert Rev Anti Infect Ther, 2017, 15(11):1041-1057.
［14］EI Shorbagy HH, Barseem NF, Abdelghani WE, et al. The value of serum procalcitonin in acute meningitis in children［J］. J Clin Nenrosci，2018，56:28-33.
［15］李祥丽,易雪岚,唐宝兴,等.降钙素原检测在化脓性脑膜炎患儿中的应用研究［J］.中华医院感染学杂志,2017,27(19):4518-4521.
［16］孙裕平,于洪波,张玉英,等.化脓性脑膜炎、病毒性脑炎患儿血清降钙素原和基质金属蛋白酶9的变化研究［J］.中国现代医学杂志,2018,28(19):45-49.
［17］Omar AS,ElShawarby A,Singh R.Early monitoring of ventriculostomy-related infections with procalcitonin in patients with ventricular drains［J］.J Clin Monit Comput,2015, 29(6):759-765.
［18］Vikse J, Henry BM, Roy J, et al.The role of serum procalcitonin in the diagnosis of bacterial meningitis in adults: a systematic review and meta-analysis［J］.Int J Infect Dis, 2015, 38(C):68-76.
［19］周漫,彭锐,李艳.血清PCT、hs-CRP在成人脑膜炎诊断中的应用价值［J］.国际检验医学杂志,2018,39(17):2102-2104.
［20］Umran RM , Radhi NH.Diagnostic value of serum procalcitonin level in differentiating bacterial from nonbacterial meningitis in children［J］.Iran J Pediatr,2014, 24(6):739-744.
［21］Henry BM, Roy J, Ramakrishnan PK , et al. Procalcitonin as a Serum Biomarker for differentiation of bacterial meningitis from viral meningitis in children: evidence from a meta-analysis［J］.Clin Pediatr (Phila), 2016, 55(8):749-764.
［22］Francois Dubos, Korczowski B , Aygun D A , et al. Serum procalcitonin level and other biological markers to distinguish between bacterial and aseptic meningitis in children: a European multicenter case cohort study［J］. Archf Pediatri & Adolesc Med, 2008, 162(12):1157.
［23］Shen HY, Gao W, Cheng JJ, et al. Direct comparison of the diagnostic accuracy between blood and cerebrospinal fluid procalcitonin level in patients with meningitis［J］.Clin Biochem，2015, 48(16/17):1079-1082.
［24］Wei TT, Hu ZD, Qin BD, et al.Diagnostic accuracy of procalcitonin in bacterial meningitis versus nonbacterial meningitis: a systematic review and meta-analysis［J］. Medicine, 2016, 95(11):e3079.
［25］Kim J, Kim SE, Park BS，et al.Procalcitonin as a diagnostic and prognostic factor for tuberculosis meningitis［J］.J Clin Neurol，2016, 12(3): 332-339.
［26］Morales-Casado MI，Julian-Jimenez A，Lobato-Casado P，et al. Predictive factors of bacterial meningitis in the patients seen in emergency departments［J］.Enferm Infecc Microbiol Clin，2017, 35（4）：220-228.
［27］Morales-Casado MI, Julián-Jiménez A, Moreno-Alonso F，et al.Diagnostic usefulness of procalcitonin and C-reactive protein in theEmergency department for predicting bacterial meningitis in the elderly［J］. Enferm Infecc Microbiol Clin，2016，34（1）：8-16.
［28］Morales Casado MI, Moreno AF, Juárez Belaunde AL, et al. Ability of procalcitonin to predict bacterial meningitis in the emergency department［J］. Neurologia, 2016, 31(1):9-17.
［29］Hu R, Gong Y, Wang Y. Relationship of serum procalcitonin levels to severity and prognosis in pediatric bacterial meningitis［J］. Clin Pediatr (Phila)，2015, 54(12):1141-1144.
［30］徐业燕,韦秋芬,李燕,等.新生儿化脓性脑膜炎临床特点分析［J］.中华妇幼临床医学杂志(电子版),2018,14(5):566-570.
［31］张艳华, 孔慧霞, 张嘉雯, 等.血清及脑脊液IL-1β、PCT、MCP-1水平变化在化脓性脑膜炎患儿病情评估及预后判断中的应用价值［J］. 中国临床实用医学杂志, 2017, 8(3):45.
［32］王瑞华，唐碧波，李如伟，等.血清降钙素原联合C反应蛋白、白细胞检测对脑膜炎患儿的诊断价值［J］.重庆医学，2017，46(34):4846-4848.
［33］Zhang XF，Zhang XQ，Wu CC，et al. Application value of procalcitonin in patients with central nervous system infection［J］.Eur Rev Med Pharmacol Sci，2017, 21(17):3944-3949.
［34］Abdelkader NA, Mahmoud WA, Saber SM. Serum procalcitonin in Egyptian patients with acute meningitis and a negative direct cerebrospinal fluid examination［J］. J Infect Public Health, 2014, 7(2):106-113.
［35］闫青, 余玲, 刘江,等. 降钙素原在鉴别不同类型脑膜炎中的临床价值分析［J］. 中华医院感染学杂志, 2016, 26(18):4122-4124.
［36］Park BS, Kim SE, Park SH，et al.Procalcitonin as a potential predicting factor for prognosis in bacterial meningitis［J］. J Clin Neurosci，2017, 36：129-133.

[1]	石大伟, 郑晓永, 靳晓丹, 赵晓曼, 陈杰, 杜幸军. XPC基因多态性rs2228001对接受卡培他滨为基础辅助化疗的结直肠癌患者预后的影响[J]. 中国临床药理学与治疗学, 2023, 28(4): 391-399.
[2]	黄凯歌, 许勤华, 王伟. 血糖、血钙对急性重症胰腺炎患者预后影响的交互作用及预测效能研究[J]. 中国临床药理学与治疗学, 2023, 28(11): 1227-1234.
[3]	黄小明, 杜野, 林少明, 沈观乐. 呼吸道微生态对晚期非小细胞肺癌患者接受PD-1抑制剂单药治疗疗效影响的探索性研究[J]. 中国临床药理学与治疗学, 2023, 28(1): 66-74.
[4]	陈云杰, 周旋, 张元斌, 王旭, 林珠, 朱素燕. ErbB2在心脏疾病中作用的研究进展[J]. 中国临床药理学与治疗学, 2022, 27(10): 1182-1189.
[5]	刘乐, 齐文博, 白玉萍, 刘乾, 尹振宇, 李晓梅, 俞阳, 陈昊. 胃癌PD-1/PD-L1免疫检查点抑制剂免疫治疗影响因素分析[J]. 中国临床药理学与治疗学, 2022, 27(1): 95-101.
[6]	李雁鹏, 赵正卿, 王雯雯, 庄建华, 赵忠新. 慢性失眠临床诊断与药物治疗研究现状[J]. 中国临床药理学与治疗学, 2021, 26(5): 487-490.
[7]	赵显超, 任佳封, 孙述昱, 宿长军. 不宁腿综合征临床特点与规范化治疗[J]. 中国临床药理学与治疗学, 2021, 26(5): 497-503.
[8]	谢彦, 李澄, 张露露, 俞飞, 臧士明, 付晶晶, 刘璐, 王峰. ⁶⁸Ga-PSMA-I&T与初诊前列腺癌病灶结合的研究[J]. 中国临床药理学与治疗学, 2021, 26(12): 1379-1385.
[9]	田亚丽, 奉林, 赵万, 谷敏, 沈涵菁, 柴晓艳. BRCA1基因多态性与转移性食管鳞癌顺铂联合卡培他滨化疗敏感性及预后关系[J]. 中国临床药理学与治疗学, 2021, 26(10): 1118-1126.
[10]	许宏磊, 徐炳欣, 俎青, 赵艳, 高朋飞, 于洋. CYP2C19基因多态性对老年急性脑梗死患者应用氯吡格雷临床预后的影响[J]. 中国临床药理学与治疗学, 2020, 25(9): 1014-1020.
[11]	汪向海, 邢敏, 吕镗烽, 刘红兵, 宋勇. 敲降长链非编码RNA 00467表达对肺腺癌患者预后的影响及其机制[J]. 中国临床药理学与治疗学, 2020, 25(8): 841-849.
[12]	张德志, 刘猛, 朱少功, 刘桂举, 季节. XELOX方案对比卡培他滨单药方案在老年结直肠癌患者术后辅助化疗中的疗效及安全性探讨[J]. 中国临床药理学与治疗学, 2020, 25(8): 926-936.
[13]	谢彦, 李澄, 张露露, 赵震宇, 黄珊珊, 王永生, 汤元翔, 王峰. ⁶⁸Ga-PSMA-I&T与前列腺癌细胞特异性结合的研究[J]. 中国临床药理学与治疗学, 2020, 25(12): 1321-1329.
[14]	郦铮铮，陈瑾，潘珍珍，潘思培，张楠. 槲皮素对奈瑟球菌感染脑膜炎大鼠继发内毒素血症的抑制作用及机制研究[J]. 中国临床药理学与治疗学, 2019, 24(6): 658-664.
[15]	李荣振，梅家转，夏云展，季节. 真实世界中R0切除术后结直肠癌患者接受卡培他滨为基础辅助化疗的预后影响因素及安全性探讨[J]. 中国临床药理学与治疗学, 2019, 24(6): 704-711.