• 成都市第三人民醫(yī)院血液科 重慶醫(yī)科大學(xué)附屬成都第二臨床學(xué)院（成都，610031）;

【摘要】　 惡性血液病患者強烈化療誘導(dǎo)的粒細胞缺乏癥常并發(fā)感染，且病死率高?？焖俣鴾蚀_地進行病原學(xué)診斷，盡早使用抗生素為治療爭取時間，可大大降低感染病死率。而臨床常用感染的實驗室診斷指標均有其局限性， 不能滿足臨床需要。目前國內(nèi)外多項研究提示降鈣素原、白介素-6、內(nèi)毒素有助于粒細胞缺乏癥伴感染的診斷及治療?，F(xiàn)就降鈣素原、白介素-6、內(nèi)毒素的來源、生物學(xué)活性及在臨床中的應(yīng)用做一綜述。

引用本文： 高華,郭海鷹. 外周血粒細胞缺乏癥感染實驗室診斷的進展. 華西醫(yī)學(xué), 2011, 26(12): 1810-1813. doi: 復(fù)制

1. 　葉任高, 陸再英. 內(nèi)科學(xué)[M]. 6版. 北京: 人民衛(wèi)生出版社, 2004: 593.
2. 　Nijsten MW, Olinga P, The TH, et al. Procalcitonin behaves as a fast responding acute phase protein in vivo and in vitro[J]. Crit Care Med, 2000, 28(2): 458-461.
3. 　Meisner M, Tschaikowsky K, Schnabel S, et al. Procalcitonin-in fluence of temperature, storage, anticoagulation and arterial or venous asservation of blood samples on procalcitonin concentration[J]. Eur J Clin Chem Clin Biochem, 1997, 35(8): 597-601.
4. 　Claude L, Philippe C, Olivier G, et al. Mass tuansfer,clearance and plasma concentration of procalcitonin during continuous venovenous hemofiltration in patients with septic shock and acute oliguric renal failure[J]. Critical Care, 2003, 6(7): 160-165.
5. 　Assicot M, Gendrel D, Carsin H, et al. High serum procalcitonin concentrations in patients with sepsis and infection[J]. Lancet, 1993, 341(8844): 515-518.
6. 　Phua J, Koay ES, Lee KH. Lactate procalcitonin and am ino-teminalpro B-type natriuretic peptide versus cytokine measurements and clinical severity scores for prognostication in septic shock[J]. Shock, 2008, 29(3): 328-333.
7. 　Ghorbani G. Procalcitonin role in differetial diagnosis of infection stages and non-infection inflammation[J]. Pak J Biol Sci, 2009, 12(4): 393-396.
8. 　Masia M, Gutiarez F, Shum C, et al. Usefulness of procalcitonin levels in community-acquired pneumonia according to the patients outcome research team pneumonia severity index[J]. Chest, 2005, 128(4): 2223-2229.
9. 　Ruokonen E, Nousiainen T, Pulkki K, et al. Procalcitonin concentration in patients with neutropenic fever[J]. Eur J Clin Microbiol Infect Dis, 1999, 18(4): 283-285.
10. 　Giamarelbs-Bourboulis EJ, Grecka P, Poulakou G, et al. Assessment of procalcitonin as a diagnostic marker of underlying infection in patients with febrile neutropenia[J]. Clin Infect Dis, 2001, 32(12): 1718-1725.
11. 　Engel A, Steinbach G, Kern P, et al. Diagnostic value of procalcitonin serum levels in neutropenic patients with fever: comparison with interleukin-8[J]. Scand J Infect Dis, 1999, 31(2): 185-189.
12. 　Kang YA, Kwon SY, Yoon HI, et al. Role of C-reactive protein and procalcitonin in differentiation of tuberculosis from bacterial community acquired pneumonia[J]. Korean J Intem Med, 2009, 24(4): 337-342.
13. 　Cvan Rossum AM,Wulkan RW,Oudesluys-Murphy AM. Procalcitonin as an early marker of infection in neonates and children[J]. Lancet Infect Dis, 2004, 4(10): 620-630.
14. 　Chiwakata CB, Maneqold C, Bonicke, et al. Procalcitonin as a parameter of disease severity and risk of mortality in patients with Plasmodium falciparum malaria[J]. J Infect Dis, 2001, 183(7): 1161-1164.
15. 　Alnawas B, Shah P. Procalcitonin in acute malaria[J]. Eur J Med Res, 1997, 2(5): 206-208.
16. 　Levy MM, Fink MP, Marshall JC, et al. 2001 Scm/ESKM/ACCP/ATS/SIS international sepsis definitions conference[J]. Crit Care Med, 2003, 31(4): 1250-1256.
17. 　Christ-Crain M, Jaccard-Stolz D, Bingisser R, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections:cluster-randomised, single-blimded intervevtion trial[J]. Lancet, 2004, 363(9409): 600-607.
18. 　Christ-Crain M, Stolz D, Bingisser R, et al. Procalcitonin guidance of antibiotic therapy in community-accquired pneumonia: a randomized trial[J]. Am J Respir Crit Care Med, 2006, 174(1): 84-93.
19. 　Stolz D, Christ-Crain M, Bingisser R, et al. Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy[J]. Chest, 2007, 131(1): 9-19.
20. 　Briel M, Christ-Crain M,Young J, et al. Procalcitonin-guided antibiotic use verse a standard approach for acute respiratory tract infections in primary care: study protocol for a randomised trail and baseline characteristics of participating general practitioners[J]. BMC Fam Pract, 2005, 6(8): 34.
21. 　Marc E, Menager C, Moulin F, et al. Procalcitonin and viral meningitis:reduction of unnecessary antibiotics by measurement during an outbreak[J]. Arch Pediatr, 2002, 9(4): 358-364.
22. 　Hillas G, Vassilakopoulos T, Plantaz P, et al. CRP and PCT as predictors of survival and septic shock in ventilator-asssociated pneumonia[J]. Eur Pespir J, 2010, 35(4): 805-811.
23. 　Tang H, Huang T, Jing J, et al. Effect of Procalcitonin-guided treatment in patients with infections a system review and mete-analysis[J]. Infection, 2009, 37(6): 497-507.
24. 　Boussekey N, Leroy O, Alfandari S, et al. Procalcitonin kinetics in the prognosis of sever community-accquired pneumonia[J]. Intensive Care Med, 2006, 32(3): 469-472.
25. 　Giamarelbs-Bourboulis EJ, Grecka P, Poulakou G, et al. Assessment of procalcitonin as a diagnosis marker of underlying infection in patients with febrile neutropenia[J]. Clin Infect Dis, 2001, 32(12): 1718-1725.
26. 　Fleischhack G, Kambeck I, Cipic, D, et al. Procalcitonin in paediatri cancer patients: its diagnostic relevance is superior to that of C-reactive protein, interleukin 6, interleukin 8, soluble interleukin 2 receptor and soluble tumor necrosis factor receptor II[J]. Br J Haematol, 2000, 111(4): 1093-1102.
27. 　Ostermann H, Kratz-Alliers K, Mesters RM, et al. Reciprocal changes in circulating interleukin-6 and its soluble receptor during evolving sepsis in leukocycopenic patients[J]. Infect Dis, 1997, 176(3): 825-828.
28. 　Spittler A, Razenberger M, Kupper H, et al. Relationship between interleukin-6 plasma concentration in patients with sepsis monocyte phenotype, monoeyte phagocytic properties, and cytokine production[J]. Clin Infect Dis, 2000, 31(6): 1338-1420.
29. 　Darrlas P, Ledoux D, Nys M, et al. Cytokine serum level during sew′re sepsis in human IL-6 as a marker of severity[J]. Ann Surg, 1992, 215(4): 356-362.
30. 　deBont ESJM, Vellenga E, Swaanenburg JCJM, et al. Plasma IL-8 and IL-6 level can be used to define a group with lower risk of septicaemia among cancer patients with fever and neutropenia[J]. Brit J Hoemotol, 1999, 107(2): 375-380.
31. 　Lehrnbecher T, Venzon D, de Haas M, et al. Assessment of measuring circulating levels of interleukin-6, interleukin-8, C-reactive protein,soluble Fc gamma receptor type Ⅲ, and mannose-binding protein in febrile children with cancer and neutropenia[J]. Clin Infect Dis, 1999, 29(2): 414-419.
32. 　Kuo TH, Chuang SC, Chang SY, et al. Ligand specificities and structual requirement of two Tachypleus plasma lectins for bacterial trapping[J]. Biochem J, 2006, 393(3): 757-766.
33. 　Nahid AM, Suggi S.Binding of porcing ficolin-alpha to lipopolysaccharides from Gram-negtive bacteri and lipoteichoic acids from Gram-positive bacteria[J]. Burns, 2001, 27(2): 145-149.
34. 　Jacobs MR, Good CE. Relationship betwween bacterial load′species virulence′ and transfusion reaction with transfusion of bacterially contaminated platelets[J]. Clin Infect Dis, 2008, 46(8): 1214-1220.
35. 　Nys M,Ledous D, Canicet JL, et al. Correlation between endotoxin level and bacterial count in bronchoalveolar fluid of ventilated patients[J]. Crit Care Med, 2000, 28(8): 2825-2831.
36. 　Van Deverter SJ, Buller HR. Endotoxaemia:an early predictor of septicaemia in febrile patients[J]. Lancet, 1988, 1(8586): 605-609.
37. 　Hass A, Rossberq MI, Hooles HL, et al. Endotoxin levels in immunocompromised children with fever[J]. J Pediatr, 1986, 109(2): 265-269.
  1. 1. 　葉任高, 陸再英. 內(nèi)科學(xué)[M]. 6版. 北京: 人民衛(wèi)生出版社, 2004: 593.
  2. 2. 　Nijsten MW, Olinga P, The TH, et al. Procalcitonin behaves as a fast responding acute phase protein in vivo and in vitro[J]. Crit Care Med, 2000, 28(2): 458-461.
  3. 3. 　Meisner M, Tschaikowsky K, Schnabel S, et al. Procalcitonin-in fluence of temperature, storage, anticoagulation and arterial or venous asservation of blood samples on procalcitonin concentration[J]. Eur J Clin Chem Clin Biochem, 1997, 35(8): 597-601.
  4. 4. 　Claude L, Philippe C, Olivier G, et al. Mass tuansfer,clearance and plasma concentration of procalcitonin during continuous venovenous hemofiltration in patients with septic shock and acute oliguric renal failure[J]. Critical Care, 2003, 6(7): 160-165.
  5. 5. 　Assicot M, Gendrel D, Carsin H, et al. High serum procalcitonin concentrations in patients with sepsis and infection[J]. Lancet, 1993, 341(8844): 515-518.
  6. 6. 　Phua J, Koay ES, Lee KH. Lactate procalcitonin and am ino-teminalpro B-type natriuretic peptide versus cytokine measurements and clinical severity scores for prognostication in septic shock[J]. Shock, 2008, 29(3): 328-333.
  7. 7. 　Ghorbani G. Procalcitonin role in differetial diagnosis of infection stages and non-infection inflammation[J]. Pak J Biol Sci, 2009, 12(4): 393-396.
  8. 8. 　Masia M, Gutiarez F, Shum C, et al. Usefulness of procalcitonin levels in community-acquired pneumonia according to the patients outcome research team pneumonia severity index[J]. Chest, 2005, 128(4): 2223-2229.
  9. 9. 　Ruokonen E, Nousiainen T, Pulkki K, et al. Procalcitonin concentration in patients with neutropenic fever[J]. Eur J Clin Microbiol Infect Dis, 1999, 18(4): 283-285.
  10. 10. 　Giamarelbs-Bourboulis EJ, Grecka P, Poulakou G, et al. Assessment of procalcitonin as a diagnostic marker of underlying infection in patients with febrile neutropenia[J]. Clin Infect Dis, 2001, 32(12): 1718-1725.
  11. 11. 　Engel A, Steinbach G, Kern P, et al. Diagnostic value of procalcitonin serum levels in neutropenic patients with fever: comparison with interleukin-8[J]. Scand J Infect Dis, 1999, 31(2): 185-189.
  12. 12. 　Kang YA, Kwon SY, Yoon HI, et al. Role of C-reactive protein and procalcitonin in differentiation of tuberculosis from bacterial community acquired pneumonia[J]. Korean J Intem Med, 2009, 24(4): 337-342.
  13. 13. 　Cvan Rossum AM,Wulkan RW,Oudesluys-Murphy AM. Procalcitonin as an early marker of infection in neonates and children[J]. Lancet Infect Dis, 2004, 4(10): 620-630.
  14. 14. 　Chiwakata CB, Maneqold C, Bonicke, et al. Procalcitonin as a parameter of disease severity and risk of mortality in patients with Plasmodium falciparum malaria[J]. J Infect Dis, 2001, 183(7): 1161-1164.
  15. 15. 　Alnawas B, Shah P. Procalcitonin in acute malaria[J]. Eur J Med Res, 1997, 2(5): 206-208.
  16. 16. 　Levy MM, Fink MP, Marshall JC, et al. 2001 Scm/ESKM/ACCP/ATS/SIS international sepsis definitions conference[J]. Crit Care Med, 2003, 31(4): 1250-1256.
  17. 17. 　Christ-Crain M, Jaccard-Stolz D, Bingisser R, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections:cluster-randomised, single-blimded intervevtion trial[J]. Lancet, 2004, 363(9409): 600-607.
  18. 18. 　Christ-Crain M, Stolz D, Bingisser R, et al. Procalcitonin guidance of antibiotic therapy in community-accquired pneumonia: a randomized trial[J]. Am J Respir Crit Care Med, 2006, 174(1): 84-93.
  19. 19. 　Stolz D, Christ-Crain M, Bingisser R, et al. Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy[J]. Chest, 2007, 131(1): 9-19.
  20. 20. 　Briel M, Christ-Crain M,Young J, et al. Procalcitonin-guided antibiotic use verse a standard approach for acute respiratory tract infections in primary care: study protocol for a randomised trail and baseline characteristics of participating general practitioners[J]. BMC Fam Pract, 2005, 6(8): 34.
  21. 21. 　Marc E, Menager C, Moulin F, et al. Procalcitonin and viral meningitis:reduction of unnecessary antibiotics by measurement during an outbreak[J]. Arch Pediatr, 2002, 9(4): 358-364.
  22. 22. 　Hillas G, Vassilakopoulos T, Plantaz P, et al. CRP and PCT as predictors of survival and septic shock in ventilator-asssociated pneumonia[J]. Eur Pespir J, 2010, 35(4): 805-811.
  23. 23. 　Tang H, Huang T, Jing J, et al. Effect of Procalcitonin-guided treatment in patients with infections a system review and mete-analysis[J]. Infection, 2009, 37(6): 497-507.
  24. 24. 　Boussekey N, Leroy O, Alfandari S, et al. Procalcitonin kinetics in the prognosis of sever community-accquired pneumonia[J]. Intensive Care Med, 2006, 32(3): 469-472.
  25. 25. 　Giamarelbs-Bourboulis EJ, Grecka P, Poulakou G, et al. Assessment of procalcitonin as a diagnosis marker of underlying infection in patients with febrile neutropenia[J]. Clin Infect Dis, 2001, 32(12): 1718-1725.
  26. 26. 　Fleischhack G, Kambeck I, Cipic, D, et al. Procalcitonin in paediatri cancer patients: its diagnostic relevance is superior to that of C-reactive protein, interleukin 6, interleukin 8, soluble interleukin 2 receptor and soluble tumor necrosis factor receptor II[J]. Br J Haematol, 2000, 111(4): 1093-1102.
  27. 27. 　Ostermann H, Kratz-Alliers K, Mesters RM, et al. Reciprocal changes in circulating interleukin-6 and its soluble receptor during evolving sepsis in leukocycopenic patients[J]. Infect Dis, 1997, 176(3): 825-828.
  28. 28. 　Spittler A, Razenberger M, Kupper H, et al. Relationship between interleukin-6 plasma concentration in patients with sepsis monocyte phenotype, monoeyte phagocytic properties, and cytokine production[J]. Clin Infect Dis, 2000, 31(6): 1338-1420.
  29. 29. 　Darrlas P, Ledoux D, Nys M, et al. Cytokine serum level during sew′re sepsis in human IL-6 as a marker of severity[J]. Ann Surg, 1992, 215(4): 356-362.
  30. 30. 　deBont ESJM, Vellenga E, Swaanenburg JCJM, et al. Plasma IL-8 and IL-6 level can be used to define a group with lower risk of septicaemia among cancer patients with fever and neutropenia[J]. Brit J Hoemotol, 1999, 107(2): 375-380.
  31. 31. 　Lehrnbecher T, Venzon D, de Haas M, et al. Assessment of measuring circulating levels of interleukin-6, interleukin-8, C-reactive protein,soluble Fc gamma receptor type Ⅲ, and mannose-binding protein in febrile children with cancer and neutropenia[J]. Clin Infect Dis, 1999, 29(2): 414-419.
  32. 32. 　Kuo TH, Chuang SC, Chang SY, et al. Ligand specificities and structual requirement of two Tachypleus plasma lectins for bacterial trapping[J]. Biochem J, 2006, 393(3): 757-766.
  33. 33. 　Nahid AM, Suggi S.Binding of porcing ficolin-alpha to lipopolysaccharides from Gram-negtive bacteri and lipoteichoic acids from Gram-positive bacteria[J]. Burns, 2001, 27(2): 145-149.
  34. 34. 　Jacobs MR, Good CE. Relationship betwween bacterial load′species virulence′ and transfusion reaction with transfusion of bacterially contaminated platelets[J]. Clin Infect Dis, 2008, 46(8): 1214-1220.
  35. 35. 　Nys M,Ledous D, Canicet JL, et al. Correlation between endotoxin level and bacterial count in bronchoalveolar fluid of ventilated patients[J]. Crit Care Med, 2000, 28(8): 2825-2831.
  36. 36. 　Van Deverter SJ, Buller HR. Endotoxaemia:an early predictor of septicaemia in febrile patients[J]. Lancet, 1988, 1(8586): 605-609.
  37. 37. 　Hass A, Rossberq MI, Hooles HL, et al. Endotoxin levels in immunocompromised children with fever[J]. J Pediatr, 1986, 109(2): 265-269.