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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/09/13 17:13:02」(JST)

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Procalcitonin (PCT) is a peptide precursor of the hormone calcitonin, the latter being involved with calcium homeostasis. It is composed of 116 amino acids and is produced by parafollicular cells (C cells) of the thyroid and by the neuroendocrine cells of the lung and the intestine.

The level of procalcitonin in the blood stream of healthy individuals is below the limit of detection (10 pg/mL) of clinical assays.^[1] The level of procalcitonin rises in a response to a proinflammatory stimulus, especially of bacterial origin. In this case, it is produced mainly by the cells of the lung and the intestine. It does not rise significantly with viral or non-infectious inflammations. With the derangements that a severe infection with an associated systemic response brings, the blood levels of procalcitonin may rise to 100 mcg/L. In serum, procalcitonin has a half-life of 25 to 30 hours. Remarkably the high procalcitonin levels produced during infections are not followed by a parallel increase in calcitonin or serum calcium levels.

Uses[edit source | edit]

Diagnosis and prognosis of sepsis[edit source | edit]

Measurement of procalcitonin can be used as a marker of severe sepsis caused by bacteria and generally grades well with the degree of sepsis,^[2] although levels of procalcitonin in the blood are very low. PCT has the greatest sensitivity (85%) and specificity (91%) for differentiating patients with systemic inflammatory response syndrome (SIRS) from those with sepsis, when compared with IL-2, IL-6, IL-8, CRP and TNF-alpha.^[3] Evidence is emerging that procalcitonin levels can reduce unnecessary antibiotic prescribing to people with lower respiratory tract infections.^[4] Currently, procalcitonin assays are widely used in the clinical environment.^[5]

Diagnosis of bacteremia[edit source | edit]

A meta-analysis reported a sensitivity of 76% and specificity of 70%.^[6]

Prognosis of pneumonia[edit source | edit]

A cluster randomized trial found that the procalcitonin level can help guide antibiotic therapy. In this trial, "on the basis of serum procalcitonin concentrations, use of antibiotics was more or less discouraged (<0.1 mcg/L or <0.25 mcg/L) or encouraged (> or =0.5 mcg/L or > or =0.25 mcg/L), respectively".^[7] However, an earlier nonrandomized, observational study reported "limited, prognostic value" of procalcitonin measurement.^[8]

Procalcitonin levels may be useful to distinguish bacterial infections from nonbacterial infections. Trials from 2008 and 2009 have shown that they may help guide therapy and reduce antibiotic use, which can help save on cost of antibiotic prescriptions and drug resistance.^[9]^[10]

References[edit source | edit]

^ Dandona P, Nix D, Wilson MF, et al. (December 1994). "Procalcitonin increase after endotoxin injection in normal subjects". J. Clin. Endocrinol. Metab. 79 (6): 1605–8. doi:10.1210/jc.79.6.1605. PMID 7989463.
^ Meisner M, Tschaikowsky K, Palmaers T, Schmidt J (1999). "Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS". Crit Care 3 (1): 45–50. doi:10.1186/cc306. PMC 29013. PMID 11056723.
^ BalcI C, Sungurtekin H, Gürses E, Sungurtekin U, Kaptanoglu B (February 2003). "Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit". Crit Care 7 (1): 85–90. doi:10.1186/cc1843. PMC 154110. PMID 12617745.
^ Schuetz P, Christ-Crain M, Thomann R, et al. (September 9, 2009). "Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial.". JAMA 302 (10): 1059–1066. doi:10.1001/jama.2009.1297. PMID 19738090.
^ Yealy DM, Fine MJ (September 9, 2009). "Measurement of serum procalcitonin: a step closer to tailored care for respiratory infections?". JAMA 302 (10): 1115–1116. doi:10.1001/jama.2009.1318. PMID 19738100.
^ Jones AE, Fiechtl JF, Brown MD, Ballew JJ, Kline JA (2007). "Procalcitonin test in the diagnosis of bacteremia: a meta-analysis". Annals of Emergency Medicine 50 (1): 34–41. doi:10.1016/j.annemergmed.2006.10.020. PMID 17161501.
^ Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, Müller B (2004). "Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial". Lancet 363 (9409): 600–7. doi:10.1016/S0140-6736(04)15591-8. PMID 14987884.
^ Brunkhorst FM, Al-Nawas B, Krummenauer F, Forycki ZF, Shah PM (2002). "Procalcitonin, C-reactive protein and APACHE II score for risk evaluation in patients with severe pneumonia". Clin. Microbiol. Infect. 8 (2): 93–100. doi:10.1046/j.1469-0691.2002.00349.x. PMID 11952722.
^ Schuetz P, Christ-Crain M, Thomann R, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA. Sep 9 2009;302(10):1059-66.
^ Briel M, Schuetz P, Mueller B, et al. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Arch Intern Med. Oct 13 2008;168(18):2000-7; discussion 2007-8.

External links[edit source | edit]

Procalcitonin - web site of the manufacturer of the PCT assay.
Procalcitonin at Lab Tests Online
Procalcitonin: analyte monograph - The Association for Clinical Biochemistry and Laboratory Medicine

UpToDate Contents

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1. 成人における市中肺炎に対する診断的アプローチ diagnostic approach to community acquired pneumonia in adults
2. 急性期反応物質 acute phase reactants
3. 成人における急性気管支炎 acute bronchitis in adults
4. 成人における重症敗血症および敗血症性ショックの評価およびマネージメント evaluation and management of severe sepsis and septic shock in adults
5. 術後発熱 postoperative fever

English Journal

The clinical usefulness of initial serum procalcitonin as an aggravation predictor in a hepatobiliary tract infection at emergency department.

Jeong WJ, So BH1, Kim HM, Wee JH, Park JH, Choi SP, Woo SH.
Nigerian journal of clinical practice.Niger J Clin Pract.2015 Sep-Oct;18(5):659-63. doi: 10.4103/1119-3077.158973.
BACKGROUND AND OBJECTIVES: The ability to predict future clinical deterioration early in patients who present to an emergency care center with a hepatobiliary tract infection is difficult. We studied the clinical usefulness of the initial serum levels of procalcitonin in a hepatobiliary tract infect
PMID 26096246

Neutrophil CD64 expression - comparison of two different flow cytometry protocols on EPICs MCL and the Leuko64(™) assay on a Celldyn Sapphire haematology analyser.

Eriksson O1, Douhan Håkansson L, Karawajczyk M, Garwicz D.
Scandinavian journal of clinical and laboratory investigation.Scand J Clin Lab Invest.2015 Sep;75(5):428-33. doi: 10.3109/00365513.2015.1031690. Epub 2015 Apr 15.
OBJECTIVE: To evaluate the Trillium Diagnostics Leuko64(™) assay on Abbott Celldyn Sapphire haematology analyser compared to two flow cytometry protocols on Beckman Coulter EPICS MCL flow cytometer.MATERIALS AND METHODS: CD64 expression on neutrophils was determined by two flow cytometry protocols
PMID 25874478

α-1-Acid glycoprotein as a biomarker for the early diagnosis and monitoring the prognosis of sepsis.

Xiao K1, Su L2, Yan P3, Han B4, Li J5, Wang H6, Jia Y1, Li X7, Xie L8.
Journal of critical care.J Crit Care.2015 Aug;30(4):744-51. doi: 10.1016/j.jcrc.2015.04.007. Epub 2015 Apr 17.
OBJECTIVE: To explore the value of α-1-acid glycoprotein (AGP) for the early diagnostic and prognostic assessment of patients with sepsis.METHODS: Eighty-five patients with systemic inflammatory response syndrome (SIRS) and 192 patients with sepsis were enrolled. White blood cell counts and serum l
PMID 25957497

Japanese Journal

臨床研究終末期皮膚悪性腫瘍患者の発熱・炎症反応上昇時におけるプロカルシトニンの有用性についての検討

高橋宏治,小林ひかり,尾松淳 [他]
皮膚科の臨床 56(9), 1298-1300, 2014-09
NAID 40020204099

胸部外科の指針心臓血管外科術後感染管理におけるプロカルシトニンの有用性

前川慶之,阿部修一,吉村幸浩 [他]
胸部外科 = The Japanese journal of thoracic surgery 67(7), 519-525, 2014-07
NAID 40020134308

敗血症性ショックに対するPMX治療の臨床評価方法(<特集>アフェレシス療法における臨床評価方法について)

清水智治,遠藤善裕,谷徹
日本アフェレシス学会雑誌 33(2), 103-109, 2014-05-31
… Procalcitonin, which is a clinically available diagnostic agent for bacterial infection, may be useful as a diagnostic tool for severity of sepsis. …
NAID 110009823172

「プロカルシトニン」

　　[★]

英: procalcitonin
関: カルシトニン

概念

甲状腺外で産生されるカルシトニン
重症感染症(敗血症、重症敗血症、敗血症ショック)で上昇する炎症のマーカーである。ただし、深在真菌症(真菌単独感染)やウイルス性の炎症では上昇しにくい(参考3)。

資料

1. 炎症マーカーと感染症

http://radio848.rsjp.net/abbott/pdf/060505.pdf

2. モダンメディア 52巻12号2006(新しい検査法)

http://www.eiken.co.jp/modern_media/backnumber/pdf/MM0612-03.pdf

3. Nkkei Medical 2011.6 p.25

「PCT」

　　[★]

[pmid7989463-1] Dandona P, Nix D, Wilson MF, et al. (December 1994). "Procalcitonin increase after endotoxin injection in normal subjects". J. Clin. Endocrinol. Metab. 79 (6): 1605–8. doi:10.1210/jc.79.6.1605. PMID 7989463.

[2] Meisner M, Tschaikowsky K, Palmaers T, Schmidt J (1999). "Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS". Crit Care 3 (1): 45–50. doi:10.1186/cc306. PMC 29013. PMID 11056723.

[3] BalcI C, Sungurtekin H, Gürses E, Sungurtekin U, Kaptanoglu B (February 2003). "Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit". Crit Care 7 (1): 85–90. doi:10.1186/cc1843. PMC 154110. PMID 12617745.

[4] Schuetz P, Christ-Crain M, Thomann R, et al. (September 9, 2009). "Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial.". JAMA 302 (10): 1059–1066. doi:10.1001/jama.2009.1297. PMID 19738090.

[Yealy2009-5] Yealy DM, Fine MJ (September 9, 2009). "Measurement of serum procalcitonin: a step closer to tailored care for respiratory infections?". JAMA 302 (10): 1115–1116. doi:10.1001/jama.2009.1318. PMID 19738100.

[6] Jones AE, Fiechtl JF, Brown MD, Ballew JJ, Kline JA (2007). "Procalcitonin test in the diagnosis of bacteremia: a meta-analysis". Annals of Emergency Medicine 50 (1): 34–41. doi:10.1016/j.annemergmed.2006.10.020. PMID 17161501.

[7] Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, Müller B (2004). "Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial". Lancet 363 (9409): 600–7. doi:10.1016/S0140-6736(04)15591-8. PMID 14987884.

[pmid11952722-8] Brunkhorst FM, Al-Nawas B, Krummenauer F, Forycki ZF, Shah PM (2002). "Procalcitonin, C-reactive protein and APACHE II score for risk evaluation in patients with severe pneumonia". Clin. Microbiol. Infect. 8 (2): 93–100. doi:10.1046/j.1469-0691.2002.00349.x. PMID 11952722.

[9] Schuetz P, Christ-Crain M, Thomann R, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA. Sep 9 2009;302(10):1059-66.

[10] Briel M, Schuetz P, Mueller B, et al. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Arch Intern Med. Oct 13 2008;168(18):2000-7; discussion 2007-8.

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procalcitonin