炎症标志物在成人呼吸机相关性肺炎早期诊断的研究进展

Advances in inflammatory markers in early diagnosis of ventilator associated pneumonia in adults

呼吸机相关性肺炎(VAP)是最常见的院内获得性感染之一,也是导致危重患者医院感染死亡的主要原因。目前VAP诊断仍无“金标准”,主要依靠临床表现、影像学和病原学的综合判断,而有效的病原学诊断依据受抗生素使用、培养时间、取材标本等影响因素而受到限制,临床上缺乏有效、特异的生物标志物,使其早期诊断困难。炎症标志物的监测仍是实际临床实践中辅助诊断VAP和抗生素管理的重要手段。降钙素原(PCT)、白介素-6(IL-6)、C-反应蛋白(CRP)、可溶性髓样细胞触发性受体-1(sTREM-1)是临床实践常见的炎症标志物,相对支气管肺泡灌洗、肺组织标本镜检等需侵入性操作及微生物的长时间培养周期,其结果更易获得,提高了细菌性呼吸道感染的早期诊断效能。目前多项研究提示PCT、IL-6、CRP、sTREM-1可辅助VAP的早期诊断,现就其研究进展进行综述。

Ventilator-associated pneumonia(VAP)is one of the most common nosocomial infections and the leading cause of death from nosocomial infections in critically ill patients.At present,there is still no"gold standard"for the diagnosis of VAP,which mainly relies on the comprehensive judgment of clinical manifestations,imaging and etiology.However,effec-tive etiological diagnosis is limited by the use of antibiotics,culture time,specimen collection and other influencing factors,and the lack of effective and specific biomarkers in clinical practice makes early diagnosis difficult.The monitoring of in-flammatory markers is still an important means to assist the diagnosis of VAP and the management of antibiotics in clinical practice.Procalcitonin(PCT),interleukin-6(IL-6),C-reactive protein(CRP),and soluble triggering receptor expressed on myeloid cell-1(sTREM-1)are common inflammatory markers in clinical practice,and clinical practice relatively bron-choalveolar lavage,lung tissue specimens to be invasive operation such as microscopy and microbial cultivation cycle for a long time,the results are more likely to get.It improves the efficiency of early diagnosis of bacterial respiratory tract infec-tion.At present,many studies have suggested that PCT,IL-6,CRP and sTREM-1 can assist in the early diagnosis of VAP,and their research progress is reviewed here.