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相關文獻
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題 名 | 生物標誌分子在加護病房重度肺炎的應用=Biomarkers of Sever Pneumonia in Intensive Care Units |
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作 者 | 吳杰亮; 詹明澄; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 7:1 民94 |
頁 次 | 頁26-31 |
分類號 | 415.463 |
關鍵詞 | 生物標記; 肺炎; C-反應蛋白; 降鈣素原; 細胞激素; Biomaker; Pneurononia; C-reactive protein; Procalcitonin; Cytokine; |
語 文 | 中文(Chinese) |
中文摘要 | 嚴重的社區性肺炎或院內感染肺炎導致呼吸衰竭常需住進加護病房,他們的死亡率極高。這些使用呼吸器病患的肺炎的診斷對臨床醫師而言,仍是一大挑戰,臨床診斷及經驗性的抗生素投藥是目前主要的治療方,但是許多非感染性的肺部浸潤無法與肺炎明確區分,造成延遲使用或無節制的使用抗生素。除了診斷的不確定性外,病程的變化與預後也相當困難,因此有許多的研究在探討肺炎的生物標記(Biomarker),來輔助診斷的建立與預後評估。肺炎三生物標誌分子相當多,這些標誌可以是病源菌或是發炎細胞所釋放出的物質,檢體則來自於血液或呼吸道的肺泡液。肺泡液中的發炎細胞的組成,內毒素的濃度,血液中的C-reactive protein與Procalcitoin都曾被研究過是否可以作為肺炎標誌分子,但是其敏感度與特異性並不理想。此外肺泡液與血液中的細胞激素和肺炎的關係的研究相當多,我們曾針對TNF-α、IL-1β、IL-6、IL-8、IL-10進行的研究,發現較高的IL-10表現與病患的死亡有關,IL-1β的濃度與肺泡液的細菌量成正相關,文獻也顯示發炎性細胞激素持續維持高濃頀時是肺炎治療無效或死亡的徵候,但是ELISA方法測量細胞激素的方法在臨床上仍不實用。最近發現的分子可溶性髓樣細胞誘導受體soluble triggering receptor expressed on myeloid (sTREM1)被提出作為肺炎診斷的標誌,他的角色仍需要進一步研究。整體而言,雖然生物標誌分子對病源菌的區分能力有限,但可以提供細菌性感染與病毒性感染判讀的參考。臨床上比較重要的是用生物標誌分子系列值評估治療成效,作為抗生素調整的依據,提升肺炎治療的水準。尋找肺炎的生物標誌分子有其臨床上的需求性,研究新分子與肺炎治療的關係,將是未來改善肺炎治療可行的方向之一。 |
英文摘要 | Severe pneumonia is a common disorder and high risk of mortality in intensive care units. Even though the guidelines of ventilator-associated pneumonia have been developed, some controversy still exists in the management of severe pneumonia. We have to differentiate the infectious and non-infectious pulmonary infiltrates by invasive or non-invasive tools. Empiric antibiotics for severe pneumonia induce multipledrug resistant strains if we have not any well-designed antibiotics strategy. Therefore, we need some markers to guide the diagnosis of severe pneumonia, initiating and stopping empiric antibiotic therapy. Biological markers of severe pneumonia are measurable and quantifiable biological parameters, which serve as indices for the diagnosis of pneumonia, monitoring the treatment response and predicting the outcome. We reviewed the biomarkers: C-reactive protein (CRP), procalcitonin (PCT), soluble triggering receptor expressed on myeloid (sTREM), and some important cytokines of pneumonia (TNF-α, IL-1β, IL-6, IL-8, IL-10). We found that those biomarkers were not strongly related to specific etiologies but could differentiate bacterial and viral pneumonia. Serial CRP, Procalcitonin and IL-6 were good marker to predict the treatment response. sTREM is a new and potential biomarker of severe pneumonia. Bronchoalveolar IL-1β was associated with the local bacterial load and IL-10 predicted poor outcome in severe pneumonia. We suggest apply those biomarkers to our daily practice. To improve the management to severe pneumonia, it is also important to search more significant biomarkers of severe pneumonia. |
本系統中英文摘要資訊取自各篇刊載內容。