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Биологические маркеры воспаления при внебольничной пневмонии
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.
Key words: inflammatory response markers, C-reactive protein, procalcitonin, community-acquired pneumonia.
Ключевые слова: маркеры воспалительного ответа, С-реактивный белок, прокальцитонин, внебольничная пневмония.
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Key words: inflammatory response markers, C-reactive protein, procalcitonin, community-acquired pneumonia.
Полный текст
Список литературы
1. Tillet W, Francis T. Serological reaction in pneumonia with a non-protein somatic fraction of Pneumococcus. J Exp Med 1930; 52: 561–71.
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
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