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1、PCT odyssey in clinical use 朱继红 北京大学人民医院 急诊科 1960 高钙液体洗脱狗甲状腺，造成Ca2+ 后命名为降钙素calcitonin (CT) 1975 CT的细胞内前体物pre-PCT及其裂解产物被发现 1980 确认PCT氨基酸序列及分子结构 循环中水平低于测量下限 只在甲状腺髓样癌及小细胞肺癌患者中发现 Thyroid MV: 13kDa AA:116 1990首次报告 Sepsis/infection vs. PCT vs. 抗生素抗生素 PCT as inflammation biomarker Results by year anything
2、that can be used as an indicator of a particular disease state or some other physiological state of an organism. PCT的生化特征 编码PCT的基因Calc-1 C cell神经元细胞神经元细胞 同源性强 生物学作用重要 循环中PCT 正常 AUC CRP (p 2 ng/ml 表明脓毒症或者非常有可能升级为败血性表明脓毒症或者非常有可能升级为败血性 休克休克 * * * * 德国重症学会脓毒症诊断指导方针德国重症学会脓毒症诊断指导方针德国重症学会脓毒症诊断指导方针德国重症学会脓毒症
3、诊断指导方针 0.05ng/ml Healthy individuals 2ng/ml Probability of sepsis is high severity assessment PCT levels increase according to severity of sepsis Harbarth S et al. Am J Respir Crit Care Med 2001, 164: 396-402 ; Meisner M et al., Critical Care 1999, 3(1): 45-50 ; Krger S. et al., Eur Respir J 2008; 3
4、1: 349355 Mortality by PCT level 0% 2% 4% 6% 8% 10% 12% 051015202530 Day Mortality, % 0.1 0.1 Huang, et.al., Annals of Emergency Medicine, Vol 51, March 2008 PCT can be used for Risk stratification of patients with CAP Low PCT levels identify patients presenting in the ED with Pneumonia that have a low risk for mortality (N=1,651). PCT PCT PCT测定的意义-总结
