血清Presepsin临床检测的研究进展  

The clinical research progress in serum Presepsin

作　　者：宁永忠 王雪茹 程田 段璐璇 李祥[1] 傅琪瑶 Ning Yongzhong;Wang Xueru;Cheng Tian;Duan Luxuan;Li Xiang;Fu Qiyao(Department of Laboratory Medicine,Chuiyangliu Hospital affiliated to Tsing-hua University,Beijing 100022,China;Class 2015,Academic Department of Laboratory Medicine,Hebei Medical University,Shijiazhuang 050017,China;Class 2015,Academic Department of Laboratory Medicine,Bengbu Medical College,Bengbu 233030,China)

机构地区：[1]清华大学附属垂杨柳医院检验科,北京100022 [2]河北医科大学检验系2015级,石家庄,050017 [3]蚌埠医学院检验系2015级,蚌埠233030

出　　处：《中华检验医学杂志》2019年第8期700-704,共5页Chinese Journal of Laboratory Medicine

摘　　要：Presepsin即sCD14-ST,是可溶性白细胞分化抗原14亚型(一种糖蛋白片段)急性时相反应标志物.它能够辅助成人脓毒症、菌血症、DNA血症判断,ROC曲线下面积分别是0.88、0.78、0.79.该值升高早于降钙素原,对脓毒症早期诊断更有意义.它和疾病严重程度成正比,能判断预后.无器官功能障碍时该值是235.0(172.0~340.3)pg/ml,1个、2个、3个或3个以上器官功能障碍时是403.5(275.8~587.3)pg/ml、844.5(559.8~1259.5)pg/ml和1412.5(893.0~2675.8)pg/ml.它是脓毒症30d死亡的独立危险因素,以>927.5pg/ml为阈值评估不良预后有较好的效能.sCD14-ST对新生儿、儿童脓毒症同样有临床价值.meta分析显示对新生儿脓毒症诊断,其AUC是0.9751,比C反应蛋白、降钙素原的AUC更大、更敏感.关于儿童的研究显示,和健康对照相比脓毒症患者组sCD14-ST显著升高.AUC为0.98,最佳阈值是990pg/ml.该值的参考范围,足月儿的75%、95%百分位数是791和1178pg/ml.成人各年龄段不超过200pg/ml.该值受肾功能影响,尚需更多前瞻性试验以进一步阐明其诊断、治疗价值.Presepsin(sCD14-ST), is an soluble leukocyte differentiation antigen 14 subtype. It is a glycoprotein fragment and a marker of acute phase reaction. For diagnosis of adult sepsis, bacteremia and bacterial DNAaemia, the area under of ROC is 0.88, 0.78 and 0.79, respectively. The levels of Presepsin increase earlier than procalcitonin, and have better clinical value for early diagnosis of sepsis. It is significantly correlated with disease severity and can be used to predict prognosis. One study mentioned that in the absence of organ dysfunction, the value was 235.0 (172.0-340.3) pg/ml, and for one, two, three or more organ dysfunction, were 403.5 (275.8-587.3) pg/ml, 844.5 (559.8-1 259.5) pg/ml, 1 412.5 (893.0-2 675.8) pg/ml (P<0.01), respectively. Another study mentioned that Presepsin is an independent risk factor for 30-day death of sepsis, and it is effective to evaluate poor prognosis with a threshold of >927.5 pg/ml. Presepsin also has clinical value for neonatal and child sepsis. The Greece meta-analysis showed that the AUC for neonatal sepsis diagnosis was 0.975 1, which was higher and more sensitive than that of CRP and procalcitonin. Turkish study on children showed a significant increase in sCD14-ST in sepsis patients compared with healthy controls. Its AUC was 0.98, the best threshold was 990 pg/ml. The reference range of this value was been studied, showing that 75% and 95% percentiles of full-term infants are 791 and 1 178 pg/ml. Adults do not exceed 200 pg/ml of all age groups. It is affected by renal function. Prospective trials are expected to further clarify its diagnostic value, more therapeutic research to elaborate its therapeutic value, and corresponding clinical practice guideline.

关 键 词：脓毒症 肽碎片 脂多糖受体 参考值 生物标记 预后 

分 类 号：R446.1[医药卫生—诊断学]