切换至 "中华医学电子期刊资源库"

中华危重症医学杂志(电子版) ›› 2024, Vol. 17 ›› Issue (02) : 164 -169. doi: 10.3877/cma.j.issn.1674-6880.2024.02.013

综述

降钙素原在急性肾损伤中的研究进展
任衍康1, 左祥荣1, 曹权1,()   
  1. 1. 210029 南京,南京医科大学第一附属医院重症医学科
  • 收稿日期:2023-03-29 出版日期:2024-04-30
  • 通信作者: 曹权
  • 基金资助:
    江苏省"333高层次人才培养工程"项目(2022-3-25-045); 江苏省青年医学人才项目(QNRC2016557); 江苏省高层次卫生人才"六个一工程"拔尖人才科研项目(LGY2019067)
  • Received:2023-03-29 Published:2024-04-30
引用本文:

任衍康, 左祥荣, 曹权. 降钙素原在急性肾损伤中的研究进展[J]. 中华危重症医学杂志(电子版), 2024, 17(02): 164-169.

降钙素原(procalcitonin,PCT)是降钙素前体,由116个氨基酸组成,相对分子质量为13 600。生理状态下,甲状腺滤泡C细胞表达PCT基因,即CALC-1,产生PCT并储存在细胞内,因此正常人血液中PCT浓度极低。但在感染或炎症状态下,CALC-1表达上调,巨噬细胞、单核细胞等产生PCT后释放至循环,导致血液中PCT浓度升高[1]。PCT半衰期为22 ~ 29 h,炎症、感染发生后,其水平在3 ~ 4 h内迅速升高,并在6 ~ 24 h达到峰值,24 h后开始下降,第5天恢复到正常水平[2]。PCT主要经肾脏、肝脏清除[3]以及血浆相关酶分解,也经特异性肽链内切酶裂解成为降钙素,但炎症发生后,该过程受到抑制,可引起血清PCT浓度进一步升高[4]。PCT是目前公认的诊断细菌感染特异度非常高的生物标志物,对抗生素降阶梯治疗也有非常好的指导价值[5]。肾功能不全可以引起PCT浓度升高,特别是严重肾功能不全的患者,PCT水平显著升高[6]

1
Vijayan AL, Vanimaya, Ravindran S, et al. Procalcitonin: a promising diagnostic marker for sepsis and antibiotic therapy[J]. J Intensive Care, 2017 (5): 51.
2
Poddar B, Gurjar M, Singh S, et al. Procalcitonin kinetics as a prognostic marker in severe sepsis/septic shock[J]. Indian J Crit Care Med, 2015, 19 (3): 140-146.
3
Sharma S, Uppal B, Manchanda V, et al. Diagnostic utility of procalcitonin as biomarker of sepsis in children[J]. Infect Dis (Lond), 2018, 50 (7): 567-568.
4
中国医药教育协会感染疾病专业委员会.感染相关生物标志物临床意义解读专家共识[J].中华结核和呼吸杂志201740(4):243-257.
5
Plata-Menchaca EP, Ferrer R. Procalcitonin is useful for antibiotic deescalation in sepsis[J]. Crit Care Med, 2021, 49 (4): 693-696.
6
Wu SC, Liang CX, Zhang YL, et al. Elevated serum procalcitonin level in patients with chronic kidney disease without infection: a case-control study[J]. J Clin Lab Anal, 2020, 34 (2): e23065.
7
Levey AS, James MT. Acute kidney injury[J]. Ann Intern Med, 2017, 167 (9): ITC66-ITC80.
8
Pérez-Fernández X, Sabater-Riera J, Sileanu FE, et al. Clinical variables associated with poor outcome from sepsis-associated acute kidney injury and the relationship with timing of initiation of renal replacement therapy[J]. J Crit Care, 2017 (40): 154-160.
9
Park JT, Lee H, Kee YK, et al. High-dose versus conventional-dose continuous venovenous hemodiafiltration and patient and kidney survival and cytokine removal in sepsis-associated acute kidney injury: a randomized controlled trial[J]. Am J Kidney Dis, 2016, 68 (4): 599-608.
10
路坤,何先弟.降钙素原在脓毒症合并急性肾损伤患者中的研究进展[J].齐齐哈尔医学院学报201940(24):3117-3120.
11
Feng Y, He H, Jia C, et al. Meta-analysis of procalcitonin as a predictor for acute kidney injury[J]. Medicine (Baltimore), 2021, 100 (10): e24999.
12
McWilliam SJ, Wright RD, Welsh GI, et al. The complex interplay between kidney injury and inflammation[J]. Clin Kidney J, 2020, 14 (3): 780-788.
13
Araujo M, Doi SQ, Palant CE, et al. Procalcitonin induced cytotoxicity and apoptosis in mesangial cells: implications for septic renal injury[J]. Inflamm Res, 2013, 62 (10): 887-894.
14
Sauer M, Doβ S, Ehler J, et al. Procalcitonin impairs liver cell viability and function in vitro: a potential new mechanism of liver dysfunction and failure during sepsis?[J]. Biomed Res Int, 2017 (2017): 6130725.
15
Yuan SM. Acute kidney injury after pediatric cardiac surgery[J]. Pediatr Neonatol, 2019, 60 (1): 3-11.
16
Cerda J, Cerda M, Kilcullen P, et al. In severe acute kidney injury, a higher serum creatinine is paradoxically associated with better patient survival[J]. Nephrol Dial Transplant, 2007, 22 (10): 2781-2784.
17
Hu Q, Zhang Y, Xu H, et al. Association between admission serum procalcitonin and the occurrence of acute kidney injury in patients with septic shock: a retrospective cohort study[J]. Sci Prog, 2021, 104 (3): 368504211043768.
18
Xin Q, Xie T, Chen R, et al. A predictive model based on inflammatory and coagulation indicators for sepsis-induced acute kidney injury[J]. J Inflamm Res, 2022 (15): 4561-4571.
19
Billings FT IV, Shaw AD. Clinical trial endpoints in acute kidney injury[J]. Nephron Clin Pract, 2014, 127 (1-4): 89-93.
20
Hardenberg JB, Stockmann H, Aigner A, et al. Critical illness and systemic inflammation are key risk factors of severe acute kidney injury in patients with COVID-19[J]. Kidney Int Rep, 2021, 6 (4): 905-915.
21
Park JE, Lee B, Yoon SJ, et al. Complementary use of presepsin with the sepsis-3 criteria improved identification of high-risk patients with suspected sepsis[J]. Biomedicines, 2021, 9 (9): 1076.
22
Nakamura Y, Hoshino K, Kiyomi F, et al. Comparison of accuracy of presepsin and procalcitonin concentrations in diagnosing sepsis in patients with and without acute kidney injury[J]. Clin Chim Acta, 2019 (490): 200-206.
23
Kim SY, Hong DY, Kim JW, et al. Predictive values of procalcitonin and presepsin for acute kidney injury and 30-day hospital mortality in patients with COVID-19[J]. Medicina (Kaunas), 2022, 58 (6): 727.
24
Testani JM, Brisco MA. Plasma NGAL: so, it really is just expensive creatinine![J]. J Am Coll Cardiol, 2016, 68 (13): 1432-1434.
25
Imoto Y, Wakasaki A, Izumida K, et al. Analysis of the diagnostic capabilities of urinary neutrophil gelatinase-associated lipocalin and serum procalcitonin for acute kidney injury at the early stage of critical care intensive care unit admission[J]. J Clin Lab Anal, 2021, 35 (7): e23852.
26
Gregoriano C, Heilmann E, Molitor A, et al. Role of procalcitonin use in the management of sepsis[J]. J Thorac Dis, 2020, 12 (S1): S5-S15.
27
Chen L, Wu X, Qin H, et al. The PCT to albumin ratio predicts mortality in patients with acute kidney injury caused by abdominal infection-evoked sepsis[J]. Front Nutr, 2021 (8): 584461.
28
Sheng X, Yang J, Yu G, et al. Procalcitonin and N-terminal pro-B-type natriuretic peptide for prognosis in septic acute kidney injury patients receiving renal replacement therapy[J]. Blood Purif, 2019, 48 (3): 262-271.
29
Hobson CE, Yavas S, Segal MS, et al. Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery[J]. Circulation, 2009, 119 (18): 2444-2453.
30
Ortega-Loubon C, Fernández-Molina M, Carrascal-Hinojal Y, et al. Cardiac surgery-associated acute kidney injury[J]. Ann Card Anaesth, 2016, 19 (4): 687-698.
31
Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment[J]. Nat Rev Nephrol, 2017, 13 (11): 697-711.
32
Clementi A, Brocca A, Virzì GM, et al. Procalcitonin and interleukin-6 levels: are they useful biomarkers in cardiac surgery patients?[J]. Blood Purif, 2017, 43 (4): 290-297.
33
Brocca A, Virzì GM, de Cal M, et al. Elevated levels of procalcitonin and interleukin-6 are linked with postoperative complications in cardiac surgery[J]. Scand J Surg, 2017, 106 (4): 318-324.
34
Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection[J]. J Am Coll Cardiol, 2015, 66 (4): 350-358.
35
McClure RS, Ouzounian M, Boodhwani M, et al. Cause of death following surgery for acute type A dissection: evidence from the Canadian thoracic aortic collaborative[J]. Aorta (Stamford), 2017, 5 (2): 33-41.
36
Ko T, Higashitani M, Sato A, et al. Impact of acute kidney injury on early to long-term outcomes in patients who underwent surgery for type A acute aortic dissection[J]. Am J Cardiol, 2015, 116 (3): 463-468.
37
Yin ZQ, Han H, Yan X, et al. Research progress on the pathogenesis of aortic dissection[J]. Curr Probl Cardiol, 2023, 48 (8): 101249.
38
Liu H, Luo Z, Liu L, et al. Inflammatory biomarkers to predict adverse outcomes in postoperative patients with acute type A aortic dissection[J]. Scand Cardiovasc J, 2020, 54 (1): 37-46.
39
Chen X, Zhou J, Fang M, et al. Procalcitonin, interleukin-6 and C-reactive protein levels predict renal adverse outcomes and mortality in patients with acute type A aortic dissection[J]. Front Surg, 2022 (9): 902108.
40
Wang R, He M, Ou XF, et al. Serum procalcitonin level predicts acute kidney injury after traumatic brain injury[J]. World Neurosurg, 2020 (141): e112-e117.
41
Schenk LM, Schneider M, Bode C, et al. Early laboratory predictors for necessity of renal replacement therapy in patients with spontaneous deep-seated intracerebral hemorrhage[J]. Front Neurol, 2021 (12): 636711.
42
Zhang F, Lu Z, Wang F. Advances in the pathogenesis and prevention of contrast-induced nephropathy[J]. Life Sci, 2020 (259): 118379.
43
Kurtul A, Murat SN, Yarlioglues M, et al. Procalcitonin as an early predictor of contrast-induced acute kidney injury in patients with acute coronary syndromes who underwent percutaneous coronary intervention[J]. Angiology, 2015, 66 (10): 957-963.
44
Gu G, Yuan X, Zhou Y, et al. Elevated high-sensitivity C-reactive protein combined with procalcitonin predicts high risk of contrast-induced nephropathy after percutaneous coronary intervention[J]. BMC Cardiovasc Disord, 2019, 19 (1): 152.
45
Raddant AC, Russo AF. Reactive oxygen species induce procalcitonin expression in trigeminal ganglia glia[J]. Headache, 2014, 54 (3): 472-484.
46
Huang HL, Nie X, Cai B, et al. Procalcitonin levels predict acute kidney injury and prognosis in acute pancreatitis: a prospective study[J]. PLoS One, 2013, 8 (12): e82250.
47
Yang D, Zhao L, Kang J, et al. Development and validation of a predictive model for acute kidney injury in patients with moderately severe and severe acute pancreatitis[J]. Clin Exp Nephrol, 2022, 26 (8): 770-787.
48
Barassi A, Pallotti F, Melzi d'Eril G. Biological variation of procalcitonin in healthy individuals[J]. Clin Chem, 2004, 50 (10): 1878.
49
袁琪茜,陈宇,杨晓玲,等.人工智能决策系统在脓毒症管理中的应用前景[J/CD].中华危重症医学杂志(电子版)202114(5):416-419.
No related articles found!
阅读次数
全文


摘要