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Биологические маркеры воспаления при внебольничной пневмонии
Зайцев А.А., Овчинников Ю.В., Кондратьева Т.В. Биологические маркеры воспаления при внебольничной пневмонии. Consilium Medicum. 2014; 16 (11): 36–41.
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Аннотация
Публикация посвящена анализу диагностических и прогностических возможностей таких биологических маркеров вовсплительного ответа, как С-реактивный белок и прокальцитонин, при внебольничной пневмонии (ВП). Авторами приводится подробный обзор зарубежных и отечественных исследований, посвященных изучению роли биомаркеров при ведении больных с ВП. Представлены результаты собственного клинического исследования, целью которого явилось изучение практических возможностей применения биомаркеров (С-реактивный белок, прокальцитонин) при лечении госпитализированных пациентов с ВП. В исследование были включены 240 больных. Показано, что использование «биомаркер-ориентированной» терапии при ВП характеризуется снижением длительности применения антибиотиков и сопровождается лучшей переносимостью лечения.
Ключевые слова: маркеры воспалительного ответа, С-реактивный белок, прокальцитонин, внебольничная пневмония.
Ключевые слова: маркеры воспалительного ответа, С-реактивный белок, прокальцитонин, внебольничная пневмония.
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The publication is devoted to the analysis of diagnostic and prognostic capabilities of biological markers of inflammatory response as C-reactive protein and procalcitonin in community-acquired pneumonia (CAP). The author gives a detailed overview of the foreign and domestic research on the role of biomarkers in the management of patients with CAP. The results of our own clinical studies, the aim of which was to study the feasibility of the use of biomarkers (CRP, PCT) in the treatment of hospitalized patients with CAP. The study included 240 patients. It is shown that the use of «biomarker-oriented» treatment for CAP is characterized by a decrease in the duration of antibiotic use and accompanied by the better tolerated treatment.
Key words: inflammatory response markers, C-reactive protein, procalcitonin, community-acquired pneumonia.
Полный текст
Список литературы
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2. MacLeod C, Avery O. The occurrence during acute infections of a protein not normally present in the blood : II. Isolation and properties of the reactive protein. J Exp Med 1941; 73 (2): 183–90.
3. Hirschfield G, Pepys M. C-reactive protein and cardiovascular disease: new insights from an old molecule. Q J Med 2003; 96 (11): 793–807.
4. Young B et al. C-reactive protein: a critical review. Pathology 1991; 23: 118–24.
5. Pepys M, Hirschfield G. C-reactive protein: a critical update. J Clin Invest 2003; 111: 1805–12.
6. Shine B et al. Solid phase radioimmunoassays for human C-reactive protein. Clin Chim Acta 1981; 117: 13–23.
7. Anderson H, McCarty M. Am J Med 1950; 8: 445.
8. Bauer S, Lamy O. Role of C-reactive protein in the diagnosis, prognosis and follow-up of community-acquired pneumonia. Rev Med Suisse 2010; 6 (269): 2068–70, 2072–3.
9. Van der Meer V, Neven A, van den Broek P, Assendelft W. Diagnostic value of C reactive protein in infections of the lower respiratory tract: systematic review. BMJ 2005; 331 (7507): 26.
10. Castro-Guardiola A, Armengou-Arxé A, Viejo-Rodríguez A et al. Differential diagnosis between community-acquired pneumonia and non-pneumonia diseases of the chest in the emergency ward. Eur J Intern Med 2000; 11: 334–9.
11. Flanders S et al. Performance of a bedside C-reactive protein test in the diagnosis of community-acquired pneumonia in adults with acute cough. Am J Med 2004; 116: 529–35.
12. Macfarlane J, Holmes W, Gard P et al. Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community. Thorax 2001; 56: 109–14.
13. Almirall J, Bolíbar I, Toran P et al. Contribution of C-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia. Chest 2004; 125: 1335–42.
14. Woodhead M, Blasi F, Ewig S et al. New guidelines for the management of adult lover respiratory tract infections. Clin Microbiol Infect 2011; 17 (6): 1–59.
15. Bafadhel M, Clark T, Reid C et al. Procalcitonin and C-reactive protein in hospitalized adult patients with community-acquired pneumonia or exacerbation of asthma or COPD. Chest 2011; 139 (6): 1410–8.
16. Авдеев С.Н., Баймаканова Г.Е., Зубаирова П.А. Возможности С-реактивного белка в диагностике бактериальной инфекции и пневмонии у больных с обострением хронической обструктивной болезни легких. Уральский мед. журн. 2008; 13: 19–24.
17. Young Ae Kang, Sung-Youn Kwon, Ho IL Yoon et al. Role of C-Reactive Protein and Procalcitonin in Differentiation of Tuberculosis from Bacterial Community Acquired Pneumonia. Korean J Intern Med 2009; 24 (4): 337–42.
18. McCarthy P, Frank A, Ablow R et al. Value of the C-reactive protein test in the differentiation of bacterial and viral pneumonia. J Pediatr 1978; 92: 454–6.
19. Korppi M., Heiskanen-Kosma T, Leinonen M et al. White blood cells, C-reactive protein and erythrocyte sedimentation rate in pneumococcal pneumonia in children. Eur Respir J 1997: 10; 1125–9.
20. Lehtomaki K. Clinical diagnosis of pneumococcal, adenoviral, mycoplasmal and mixed pneumonias in young men. Eur Respir J 1988; 1: 324–9.
21. Garcia Vazquez E, Martínez J, Mensa J et al. C-reactive protein levels in community-acquired pneumonia. Eur Respir J 2003; 21: 702–5.
22. Krüger S, Ewig S, Papassotiriou J et al. CAPNETZ Study Group. Inflammatory parameters predict etiologic patterns but do not allow for individual prediction of etiology in patients with CAP: results from the German competence network CAPNETZ. Respir Res 2009; 10 (1): 65.
23. España P, Capelastegui A, Bilbao A et al. Population Study of Pneumonia (PSoP) Group. Utility of two biomarkers for directing care among patients with non-severe community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 2012; 31 (12): 3397–405.
24. Agapakis D, Tsantilas D et al. Coagulation and inflammation biomarkers may help predict the severity of community-acquired pneumonia. Respirology 2010; 15 (5): 796–803.
25. Hohenthal U, Hurme S et al. Utility of C-reactive protein in assessing the disease severity and complications of community-acquired pneumonia. Clin Microbiol Infect 2009; 15 (11): 1026–32.
26. Smith R. C-reactive protein in simple community-acquired pneumonia. Chest 1995; 107: 1028–31.
27. Bruns A, Oosterheert J, Hak E, Hoepelman A. Usefulness of consecutive C-reactive protein measurements in follow-up of severe community-acquired pneumonia. Eur Respir J 2008; 32: 726–32.
28. Ruiz-González A, Falguera M, Porcel JM et al. C-reactive protein for discriminating treatment failure from slow responding pneumonia. Eur J Int Med 2010; 21: 548–52.
29. Ménendez R, Martínez R et al. Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia. Thorax 2009; 64 (7): 587–91.
30. Chalmers J, Singanayagam A, Hill A. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Med 2008; 121: 219–25.
31. Lobo S, Lobo F, Bota D et al. C-reactive protein levels correlate with mortality and organ failure in critically ill patients. Chest 2003; 123: 2043–9.
32. Coelho L, Póvoa P, Almeida E et al. Usefulness of C-reactive protein in monitoring the severe community-acquired pneumonia clinical course. Crit Care 2007; 11 (4): 92.
33. Le Moullec J, Jullienne A, Chenais J et al. The complete sequence of human preprocalcitonin. FEBS 1984; 167: 93–7.
34. Becker K, Muller B, Nylen E et al. Calcitonin gene family of peptides. Becker K., ed. Principles and Practice of Endocrinology and Metabolism. Philadelphia: J.B Lippincott, 2001;
p. 520–34.
35. Моррисон В.В., Божедомов А.Ю. Значение определения концентрации прокальцитонина плазмы крови в диагностике септических состояний. Саратовский науч.-мед. журн. 2010; 6 (2): 261–7.
36. Meisner M. Procalcitonin – a new, innovative infection parameter. Berlin, Brahms Diagnostica, 1996; 3–41.
37. Bohuon C. A brief history of procalcitonin. Intensive Care Med 2000; 26 (S2): 146–7.
38. Assicot M, Gendrel D, Carsin H et al. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993; 341 (8844): 515–8.
39. Christ-Crain М, Opal S. Clinical review: The role of biomarkers in the diagnosis and management of community-acquired pneumonia. Crit Care 2010; 14 (1): 203.
40. Krüger S, Ewig S et al. CAPNETZ Study Group. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J 2008; 31 (2): 349–55.
41. Upadhyay S, Niederman M. Biomarkers: What is Their Benefit in the Identification of Infection, Severity Assessment, and Management of Community-acquired Pneumonia? Infect Dis Clin North Am 2013; 27 (1): 19–31.
42. Niu W, Wan Y, Li M et al. The diagnostic value of serum procalcitonin, IL-10 and C-reactive protein in community acquired pneumonia and tuberculosis. Eur Rev Med Pharmacol Sci 2013; 17 (24): 3329–33.
43. Horie M, Ugajin M, Suzuki M et al. Diagnostic and prognostic value of procalcitonin in community-acquired pneumonia. Am J Med Sci 2012; 343 (1): 30–5.
44. Tamura M, Watanabe M, Nakajima A et al. Serial quantification of procalcitonin (PCT) predicts clinical outcome and prognosis in patients with community-acquired pneumonia (CAP). J Infect Chemother 2014; 2: 97–103.
45. Julián-Jiménez A, Timón Zapata J et al. Diagnostic and prognostic power of biomarkers to improve the management of community acquired pneumonia in the emergency department. Enferm Infecc Microbiol Clin 2014. http://www.ncbi.nlm.nih.gov/pubmed/24182623
46. Kim J, Seo J et al. Usefulness of plasma procalcitonin to predict severity in elderly patients with community-acquired pneumonia. Tuberc Respir Dis 2013; 74 (5): 207–14.
47. Ugajin M, Yamaki K et al. Predictive Values of Semi-Quantitative Procalcitonin Test and Common Biomarkers for the Clinical Outcomes of Community-Acquired Pneumonia. Respir Care 2014; 59 (4): 564–73.
48. Christ-Crain M, Stolz D, Bingisser R et al. Procalcitonin Guidance of Antibiotic Therapy in Community-acquired Pneumonia. Am J Respir Crit Care Med 2006; 174: 84–93.
49. Long W, Deng X et al. Procalcitonin guidance for reduction of antibiotic use in low-risk outpatients with community-acquired pneumonia. Respitology 2011; 16 (5): 819–24.
50. Schuetz P, Suter-Widmer I, Chaudri A et al. Procalcitonin-Guided Antibiotic Therapy and Hospitalisation in Patients with Lower Respiratory Tract Infections (ProHOSP) Study Group. Prognostic value of procalcitonin in community-acquired pneumonia. Eur Respir J 2011; 37 (2): 384–92.
51. Albrich W, Dusemund F, Bucher B et al. ProREAL Study Team. Effectiveness and safety of procalcitonin-guided antibiotic therapy in lower respiratory tract infections in «real life»: an international, multicenter poststudy survey (ProREAL). Arch Intern Med 2012; 172 (9): 715–22.
52. Hui Li, Yi-Feng Luo et al. Meta-Analysis and Systematic Review of Procalcitonin-Guided Therapy in Respiratory Tract Infections. Antimicrob Agents and Chemother 2011; 55 (12): 5900–6.
53. Schuetz P, Müller B, Christ-Crain M et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Evid Based Child Health 2013; 8 (4): 1297–371.
54. Чучалин А.Г., Синопальников А.И., Козлов Р.С. и др. Внебольничная пневмония у взрослых. Практические рекомендации по диагностике, лечению и профилактике. М., 2010.
2. MacLeod C, Avery O. The occurrence during acute infections of a protein not normally present in the blood : II. Isolation and properties of the reactive protein. J Exp Med 1941; 73 (2): 183–90.
3. Hirschfield G, Pepys M. C-reactive protein and cardiovascular disease: new insights from an old molecule. Q J Med 2003; 96 (11): 793–807.
4. Young B et al. C-reactive protein: a critical review. Pathology 1991; 23: 118–24.
5. Pepys M, Hirschfield G. C-reactive protein: a critical update. J Clin Invest 2003; 111: 1805–12.
6. Shine B et al. Solid phase radioimmunoassays for human C-reactive protein. Clin Chim Acta 1981; 117: 13–23.
7. Anderson H, McCarty M. Am J Med 1950; 8: 445.
8. Bauer S, Lamy O. Role of C-reactive protein in the diagnosis, prognosis and follow-up of community-acquired pneumonia. Rev Med Suisse 2010; 6 (269): 2068–70, 2072–3.
9. Van der Meer V, Neven A, van den Broek P, Assendelft W. Diagnostic value of C reactive protein in infections of the lower respiratory tract: systematic review. BMJ 2005; 331 (7507): 26.
10. Castro-Guardiola A, Armengou-Arxé A, Viejo-Rodríguez A et al. Differential diagnosis between community-acquired pneumonia and non-pneumonia diseases of the chest in the emergency ward. Eur J Intern Med 2000; 11: 334–9.
11. Flanders S et al. Performance of a bedside C-reactive protein test in the diagnosis of community-acquired pneumonia in adults with acute cough. Am J Med 2004; 116: 529–35.
12. Macfarlane J, Holmes W, Gard P et al. Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community. Thorax 2001; 56: 109–14.
13. Almirall J, Bolíbar I, Toran P et al. Contribution of C-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia. Chest 2004; 125: 1335–42.
14. Woodhead M, Blasi F, Ewig S et al. New guidelines for the management of adult lover respiratory tract infections. Clin Microbiol Infect 2011; 17 (6): 1–59.
15. Bafadhel M, Clark T, Reid C et al. Procalcitonin and C-reactive protein in hospitalized adult patients with community-acquired pneumonia or exacerbation of asthma or COPD. Chest 2011; 139 (6): 1410–8.
16. Авдеев С.Н., Баймаканова Г.Е., Зубаирова П.А. Возможности С-реактивного белка в диагностике бактериальной инфекции и пневмонии у больных с обострением хронической обструктивной болезни легких. Уральский мед. журн. 2008; 13: 19–24.
17. Young Ae Kang, Sung-Youn Kwon, Ho IL Yoon et al. Role of C-Reactive Protein and Procalcitonin in Differentiation of Tuberculosis from Bacterial Community Acquired Pneumonia. Korean J Intern Med 2009; 24 (4): 337–42.
18. McCarthy P, Frank A, Ablow R et al. Value of the C-reactive protein test in the differentiation of bacterial and viral pneumonia. J Pediatr 1978; 92: 454–6.
19. Korppi M., Heiskanen-Kosma T, Leinonen M et al. White blood cells, C-reactive protein and erythrocyte sedimentation rate in pneumococcal pneumonia in children. Eur Respir J 1997: 10; 1125–9.
20. Lehtomaki K. Clinical diagnosis of pneumococcal, adenoviral, mycoplasmal and mixed pneumonias in young men. Eur Respir J 1988; 1: 324–9.
21. Garcia Vazquez E, Martínez J, Mensa J et al. C-reactive protein levels in community-acquired pneumonia. Eur Respir J 2003; 21: 702–5.
22. Krüger S, Ewig S, Papassotiriou J et al. CAPNETZ Study Group. Inflammatory parameters predict etiologic patterns but do not allow for individual prediction of etiology in patients with CAP: results from the German competence network CAPNETZ. Respir Res 2009; 10 (1): 65.
23. España P, Capelastegui A, Bilbao A et al. Population Study of Pneumonia (PSoP) Group. Utility of two biomarkers for directing care among patients with non-severe community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 2012; 31 (12): 3397–405.
24. Agapakis D, Tsantilas D et al. Coagulation and inflammation biomarkers may help predict the severity of community-acquired pneumonia. Respirology 2010; 15 (5): 796–803.
25. Hohenthal U, Hurme S et al. Utility of C-reactive protein in assessing the disease severity and complications of community-acquired pneumonia. Clin Microbiol Infect 2009; 15 (11): 1026–32.
26. Smith R. C-reactive protein in simple community-acquired pneumonia. Chest 1995; 107: 1028–31.
27. Bruns A, Oosterheert J, Hak E, Hoepelman A. Usefulness of consecutive C-reactive protein measurements in follow-up of severe community-acquired pneumonia. Eur Respir J 2008; 32: 726–32.
28. Ruiz-González A, Falguera M, Porcel JM et al. C-reactive protein for discriminating treatment failure from slow responding pneumonia. Eur J Int Med 2010; 21: 548–52.
29. Ménendez R, Martínez R et al. Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia. Thorax 2009; 64 (7): 587–91.
30. Chalmers J, Singanayagam A, Hill A. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Med 2008; 121: 219–25.
31. Lobo S, Lobo F, Bota D et al. C-reactive protein levels correlate with mortality and organ failure in critically ill patients. Chest 2003; 123: 2043–9.
32. Coelho L, Póvoa P, Almeida E et al. Usefulness of C-reactive protein in monitoring the severe community-acquired pneumonia clinical course. Crit Care 2007; 11 (4): 92.
33. Le Moullec J, Jullienne A, Chenais J et al. The complete sequence of human preprocalcitonin. FEBS 1984; 167: 93–7.
34. Becker K, Muller B, Nylen E et al. Calcitonin gene family of peptides. Becker K., ed. Principles and Practice of Endocrinology and Metabolism. Philadelphia: J.B Lippincott, 2001;
p. 520–34.
35. Моррисон В.В., Божедомов А.Ю. Значение определения концентрации прокальцитонина плазмы крови в диагностике септических состояний. Саратовский науч.-мед. журн. 2010; 6 (2): 261–7.
36. Meisner M. Procalcitonin – a new, innovative infection parameter. Berlin, Brahms Diagnostica, 1996; 3–41.
37. Bohuon C. A brief history of procalcitonin. Intensive Care Med 2000; 26 (S2): 146–7.
38. Assicot M, Gendrel D, Carsin H et al. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993; 341 (8844): 515–8.
39. Christ-Crain М, Opal S. Clinical review: The role of biomarkers in the diagnosis and management of community-acquired pneumonia. Crit Care 2010; 14 (1): 203.
40. Krüger S, Ewig S et al. CAPNETZ Study Group. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J 2008; 31 (2): 349–55.
41. Upadhyay S, Niederman M. Biomarkers: What is Their Benefit in the Identification of Infection, Severity Assessment, and Management of Community-acquired Pneumonia? Infect Dis Clin North Am 2013; 27 (1): 19–31.
42. Niu W, Wan Y, Li M et al. The diagnostic value of serum procalcitonin, IL-10 and C-reactive protein in community acquired pneumonia and tuberculosis. Eur Rev Med Pharmacol Sci 2013; 17 (24): 3329–33.
43. Horie M, Ugajin M, Suzuki M et al. Diagnostic and prognostic value of procalcitonin in community-acquired pneumonia. Am J Med Sci 2012; 343 (1): 30–5.
44. Tamura M, Watanabe M, Nakajima A et al. Serial quantification of procalcitonin (PCT) predicts clinical outcome and prognosis in patients with community-acquired pneumonia (CAP). J Infect Chemother 2014; 2: 97–103.
45. Julián-Jiménez A, Timón Zapata J et al. Diagnostic and prognostic power of biomarkers to improve the management of community acquired pneumonia in the emergency department. Enferm Infecc Microbiol Clin 2014. http://www.ncbi.nlm.nih.gov/pubmed/24182623
46. Kim J, Seo J et al. Usefulness of plasma procalcitonin to predict severity in elderly patients with community-acquired pneumonia. Tuberc Respir Dis 2013; 74 (5): 207–14.
47. Ugajin M, Yamaki K et al. Predictive Values of Semi-Quantitative Procalcitonin Test and Common Biomarkers for the Clinical Outcomes of Community-Acquired Pneumonia. Respir Care 2014; 59 (4): 564–73.
48. Christ-Crain M, Stolz D, Bingisser R et al. Procalcitonin Guidance of Antibiotic Therapy in Community-acquired Pneumonia. Am J Respir Crit Care Med 2006; 174: 84–93.
49. Long W, Deng X et al. Procalcitonin guidance for reduction of antibiotic use in low-risk outpatients with community-acquired pneumonia. Respitology 2011; 16 (5): 819–24.
50. Schuetz P, Suter-Widmer I, Chaudri A et al. Procalcitonin-Guided Antibiotic Therapy and Hospitalisation in Patients with Lower Respiratory Tract Infections (ProHOSP) Study Group. Prognostic value of procalcitonin in community-acquired pneumonia. Eur Respir J 2011; 37 (2): 384–92.
51. Albrich W, Dusemund F, Bucher B et al. ProREAL Study Team. Effectiveness and safety of procalcitonin-guided antibiotic therapy in lower respiratory tract infections in «real life»: an international, multicenter poststudy survey (ProREAL). Arch Intern Med 2012; 172 (9): 715–22.
52. Hui Li, Yi-Feng Luo et al. Meta-Analysis and Systematic Review of Procalcitonin-Guided Therapy in Respiratory Tract Infections. Antimicrob Agents and Chemother 2011; 55 (12): 5900–6.
53. Schuetz P, Müller B, Christ-Crain M et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Evid Based Child Health 2013; 8 (4): 1297–371.
54. Чучалин А.Г., Синопальников А.И., Козлов Р.С. и др. Внебольничная пневмония у взрослых. Практические рекомендации по диагностике, лечению и профилактике. М., 2010.
Авторы
А.А.Зайцев1, Ю.В.Овчинников2, Т.В.Кондратьева3
1. ФГКУ Главный военный клинический госпиталь им. акад. Н.Н.Бурденко Минобороны России, Москва
2. Главное военно-медицинское управление Минобороны России, Москва
3. ФГКУ Окружной военный клинический госпиталь 1586 Минобороны России, Подольск
1. ФГКУ Главный военный клинический госпиталь им. акад. Н.Н.Бурденко Минобороны России, Москва
2. Главное военно-медицинское управление Минобороны России, Москва
3. ФГКУ Окружной военный клинический госпиталь 1586 Минобороны России, Подольск
________________________________________________
A.A.Zaytsev, Yu.V.Ovchinnikov, T.V.Kondrateva
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