炎性指标和临床意义.pptVIP

脓毒症患者BNP升高的机制不完全清楚,可能原因是脓毒症患者大量炎性因子(白介素-6,肿瘤坏死因子等)和内毒素促进心脏合成释放BNP,另外,脓毒症存在高动力循环,心房及心室张力增加,促进BNP合成及释放。 知识回顾Knowledge Review Comment We must never over sell the benefits of PCT. It is not the perfect bacterial biomarker – but it is the best there is today on the market. It will give false positive and false negative results. Specificity is high but not 100%. Of importance to note is Never test neonates under 2 days old (high PCT and there are no standardized cut-offs) In fact all babies under 2 days will test positive. If in doubt then repeat PCT 6-24 hours in case you have tested PCT too early in the disease course, therefore missing the infection. IL-6多种组织和细胞都可以分泌，作用于多种器官和组织发挥不同的生物学作用 如：IL-6作用肝细胞，可以诱导肝脏细胞合成和分泌CRP 所以，IL-6是比CRP产生更早的炎症介质，理论上凡是检测CRP的样本都可以检测IL-6 1. Song M, Kellum JA. Interleukin-6. Crit Care Med 2005; 33 (Suppl12): 463-465. 2. Groeneveld AB, et al. Circulating inflammatory mediators in patients with fever: predicting bloodstream infection. Clin diagn lab immunol. 2001;8:1189-95 3. Giannoudis PV, Harwood PJ, Loughenbury P, Van Griensven M, Krettek C, Pape HC. Correlation between IL-6 levels and the systemic Inflammatory response score: Can an IL-6 cutoff predict a SIRS state? J Trauma 2008;65:646-652. 4. Tschoeke SK, Hellmuth M, Hostmann A, Ertel W, Oberholzer A. The early second hit in trauma management augments the proinflammatory immune response to multiple injuries. J Trauma 2007;62:1396-1404. 1. Park JY, Pillinger MH. Interleukin-6 in the Pathogenesis of Rheumatoid Arthritis. Bull NYU Hosp Jt Dis 2007;65(Suppl1):4-10. 2. Gabay C. Interleukin-6 and chronic inflammation. Arthritis Res Ther 2006;8(Suppl2):2. IL-6是半衰期最长（45min）的炎症介质，相对稳定。出现在疾病早期，为脓毒症的早期预警指标，提示患者发生脓毒症的风险增高。 ELISA法 胶体金法 WBC 白细胞计数 Endotoxin 内毒素 IL-6 白介素-6 IL-10 白介素-10 TNF 肿瘤坏死因子 Procalcitonin 降钙素原 CRP C反应蛋白 Protein C HMG-1 sTREM-1 ........ 临床常选择的实验室指标 炎性指标与临床意义 降钙素原 PCT 血清降钙素(CT)的前肽物质 分子量：14.5 kDa 由116个氨基酸组成的糖蛋白质 无激素活性 11号染色体上 的单拷贝基因 转录 甲状腺滤泡细胞 降钙素原前体 内源多肽酶 降钙素原 PCT 分