[临床医学]PCT.ppt

临床医生极力想避免疾病出现如此严重的状态 Systemic Inflammatory Response Syndrome 全身炎症反应综合征 （满足以下2个或以上条件） 体温 38℃ or 36 ℃ 心率 90/min 呼吸急促 20min or HRventilation  (CO2 32 Torr, 4.3kPa) 白细胞计数 12,000 or 4,000/mm3 or 10% 未成熟中性白细胞 脓毒血症的诊断－临床指征、微生物学、生物标记物 对脓毒血症的诊断、预后及治疗监测各生物学指标的评估性能 临床证据证实：提高细菌感染/脓毒血症的诊断质量 在细菌感染后，PCT浓度快速地升高 在脓毒血症中，不同标志物的动力学变化 Why is this fast response important?为什么快速的响应是非常重要的？ Why is this fast response important?为什么快速的响应是非常重要的？ Rising PCT levels is an indicator of: 升高的PCT浓度水平提示： Severe Bacterial infection 严重的细菌感染 Bad Prognosis 预后不良 (patient getting worse 患者病情恶化). Case Progression 病情进展 Laboratory data returns 返回的实验室数据 WBC count 4800/mm3 ( 3500-9000/mm3 ) Procalcitonin 1.67 ng/mL ( 0.5 ng/ml ) NT proBNP 200 (reference cut off 450 pg/mL)? Pneumonia is likely, and empirical antibiotics treatment was started 肺炎的可能性很大，立即开始抗生素治疗策略 Procalcitonin as an early marker of infection in neonates and children Study Goal Ability of PCT to differentiate early between a life-threatening infection and a less severe infection (localized bacterial or viral) in neonates and children 针对儿童及新生儿患者，在威胁 生命的严重感染与轻度的感染二 者的早期诊断与区分中，PCT的 临床作用评估 Study Review-Article (not a Meta-Analysis), ?165 publications until 12/2003 ? 46 papers of them are evaluated Comparison with CRP Patients neonates prematures children Procalcitonin as an early marker of infection in neonates and children Results PCT is an excellent marker for severe systemic infections in children In neonates PCT is superior to CRP and leukocyte count. Sepsis, septic shock, meningitis PCT 83 – 100 % Sensitivity 70 – 100 % Specificity CRP 73 – 88 % Sensitivity 50 – 89 % Specificity Physical examination: Left leg: local heat with erythema, no crepitation Check CBC/DC, CRP, Na, K, BUN, Cr, ALT Check PCT Cellulitis treatment Antibiotics are usually used to treat cellulitis. If the infection is limited to a small area, has not spr