降钙素原在外科中的应用课件.ppt
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1、降钙素原( Procalcitonin )在外科临床中的应用,普通外科 张晓圣,Company Logo,Contents,Company Logo,概 述,降钙素原(Procalcitonin,PCT)是一种由116个氨基酸组成,分子量大约为13KD的糖蛋白,是降钙素的前肽物,无降钙素样的激素活性,其分子由降钙素、下钙素和一个含57个氨基酸的N-末端碎片组成。PCT半衰期为25-30h,在体内稳定性很好,由位于11号染色体上(11P15,4)的单拷贝基因编码。,Image information in product Title Master-www.iclickart.co.kr - Im
2、age licensed by affiliates Slide Master www.iclickart.co.kr- Image licensed by affiliates Note to customers: This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,北京大学第三医院海淀院区,Company Logo,概 述,1993年,法国学者(M Asscot)第一个发现PCT在严重细菌感
3、染时显著升高,而在不是细菌感染时不升高或轻微升高。从而可以在临床上鉴别出细菌感染和非细菌感染。评价细菌感染/脓毒症及其监测的最新替代指标(2003年发表的国际脓毒症定义将PCT作为判定脓毒症的炎症指标 Crit Care Med 2003;31:1250-56 ) 。降钙素原(PCT)是近年来应用于临床的重症感染监测指标,对全身炎症反应综合征和全身性感染有较高的诊断价值。特点:不受机体免疫抑制状态的影响。,Image information in product Title Master-www.iclickart.co.kr - Image licensed by affiliates Sl
4、ide Master www.iclickart.co.kr- Image licensed by affiliates Note to customers: This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,北京大学第三医院海淀院区,Company Logo,概 述,PCT产生部位:正常情况下由甲状腺的髓质细胞分泌,不释放入周围循环血中,在体内很稳定,不会降解成为有激素样活性的降钙素。健康人
5、血清PCT的浓度为0.1ug/L,病理情况下,可升高至100ug/L,大部分由甲状腺以外的组织产生。研究表明,甲状腺全部切除的病人,当严重细菌感染时,血PCT水平仍然很高,其确切产生部位还不清楚(神经内分泌细胞、肺脏、肝脏中的巨噬单核cell)。PCT的代谢:至今为止未发现PCT排出的特定途径,它经肾脏排出很少。数据表明严重肾衰病人不大量升高。,Image information in product Title Master-www.iclickart.co.kr - Image licensed by affiliates Slide Master www.iclickart.co.kr-
6、 Image licensed by affiliates Note to customers: This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,北京大学第三医院海淀院区,Company Logo,概 述,Image information in product Title Master-www.iclickart.co.kr - Image licensed by affiliates S
7、lide Master www.iclickart.co.kr- Image licensed by affiliates Note to customers: This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,北京大学第三医院海淀院区,海淀医院:血清PCT测定采用双抗夹心免疫发光法,血清灵敏度为0.1 ng/ ml,仪器和试剂由德国柏林B.R.A. H. M.S Diagnostica公司提
8、供。 ¥:180 元(医保范围内),Company Logo,细菌感染严重程度的判断,Image information in product Title Master-www.iclickart.co.kr - Image licensed by affiliates Slide Master www.iclickart.co.kr- Image licensed by affiliates Note to customers: This image has been licensed to be used within this PowerPoint template only. You
9、may not extract the image for any other use.,北京大学第三医院海淀院区,在感染疾病严重程度的发展过程中,PCT随着严重程度的不同(局部感染、脓毒血症、严重脓毒血症、脓毒性休克),呈现由低到高的浓度变化,PCT血中浓度与病程发展呈正相关对于感染程度及器官机能障碍的严重性进行准确的判断,Company Logo,概 述,Image information in product Title Master-www.iclickart.co.kr - Image licensed by affiliates Slide Master www.iclickart
10、.co.kr- Image licensed by affiliates Note to customers: This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,北京大学第三医院海淀院区,降钙素在正常人体的产生部位,细菌感染诱导降钙素原的产生部位(不确定),Company Logo,PCT产生机理图,Image information in product Title Master-www.i
11、clickart.co.kr - Image licensed by affiliates Slide Master www.iclickart.co.kr- Image licensed by affiliates Note to customers: This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,北京大学第三医院海淀院区,细菌与病毒感染时PCT的合成,Adapted from Chri
12、st-Crain et al. 2005区分全身性细菌感染与病毒感染的鉴别:后者0.5ng/ml,Company Logo,PCT对脓毒症诊断具有最高的敏感性和特异性,Image information in product Title Master-www.iclickart.co.kr - Image licensed by affiliates Slide Master www.iclickart.co.kr- Image licensed by affiliates Note to customers: This image has been licensed to be used w
13、ithin this PowerPoint template only. You may not extract the image for any other use.,北京大学第三医院海淀院区,2003年国际年会,PCT被定为脓毒血症唯一的金标准(感觉有点像做广告),Company Logo,对外科临床诊疗的判断,Image information in product Title Master-www.iclickart.co.kr - Image licensed by affiliates Slide Master www.iclickart.co.kr- Image license
14、d by affiliates Note to customers: This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,北京大学第三医院海淀院区,PCT显著地提高了临床诊断的准确率,Harbarth S. Am J Respir Crit Care Med 2001,Company Logo,区别感染及其他原因引起的发热,Image information in product Title M
15、aster-www.iclickart.co.kr - Image licensed by affiliates Slide Master www.iclickart.co.kr- Image licensed by affiliates Note to customers: This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,北京大学第三医院海淀院区,非感染、导管相关性菌血症、脓毒症、重症脓毒
16、症和脓毒症休克 PCT CRP,各组PCT水平有显著差别(P0.05),且与疾病严重程度成正相关。PCT是可靠的诊断指标。Kim KE, . Korean J Lab Med. 2010 Apr;30(2):153-9,Company Logo,PCT对真菌和病毒的区分,Image information in product Title Master-www.iclickart.co.kr - Image licensed by affiliates Slide Master www.iclickart.co.kr- Image licensed by affiliates Note to
17、customers: This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,北京大学第三医院海淀院区,区别细菌及病毒感染的原理,1、病毒感染时,释放INF-和IL-1,前者阻断了降钙素原释放;2、而细菌感染时只有IL-1,造成了其大量释放。Adapted from Linscheid et al. 2003,Company Logo,外科术后应用,外科术后、大面积创伤、烧伤等、患者血清PCT浓度变
18、化1、72小时以内,PCT血清浓度会明显上升2、72小时以后、无细菌性感染,PCT急剧下 降3、如果患者在以后仍出现持续性发热等感染 症状,建议每隔12天可进行PCT监测。,Image information in product Title Master-www.iclickart.co.kr - Image licensed by affiliates Slide Master www.iclickart.co.kr- Image licensed by affiliates Note to customers: This image has been licensed to be use
19、d within this PowerPoint template only. You may not extract the image for any other use.,北京大学第三医院海淀院区,Company Logo,PCT用于外科术后评估,Image information in product Title Master-www.iclickart.co.kr - Image licensed by affiliates Slide Master www.iclickart.co.kr- Image licensed by affiliates Note to customers
20、: This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,北京大学第三医院海淀院区,术后脓毒症的检测和预后的评估,术后立即检测(D0-D1):PCT水平显著升高(2ng/ml)是脓毒症开始的早期指标。,Company Logo,PCT对术后有无并发症的判断,Image information in product Title Master-www.iclickart.co.kr - Image l
21、icensed by affiliates Slide Master www.iclickart.co.kr- Image licensed by affiliates Note to customers: This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,北京大学第三医院海淀院区,外科术后:术后低水平的PCT提示无并发症,明显优于其他指标,Company Logo,术后感染的判断,Image
22、 information in product Title Master-www.iclickart.co.kr - Image licensed by affiliates Slide Master www.iclickart.co.kr- Image licensed by affiliates Note to customers: This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,北京大
23、学第三医院海淀院区,细菌感染后PCT特异性增高(ROC曲线),细菌感染与非细菌感染的鉴别诊断PCT:88%敏感性/81%特异性CRP:75%敏感性67%特异性术后2天内PCT2,可判定为感染的准确率为9798%,Company Logo,术后感染的判断,Image information in product Title Master-www.iclickart.co.kr - Image licensed by affiliates Slide Master www.iclickart.co.kr- Image licensed by affiliates Note to customers
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