对临床上一个拟诊肺部感染的患者, 临床医生通常依据症状、白细胞总数和分类计数, 以及胸部影像学检查作出诊断, 以期尽早开始治疗, 此时抗生素的选择只能是经验性的, 等治疗后随访观察胸片上的浸润影有无吸收才能确定此浸润影是否为感染性的。换言之, 临床症状及影像学检查对于鉴别感染性和非感染性肺部疾病缺乏特异性, 而肺部感染的诊断多属于回顾性的。 目前, 有一些生物标志物用于帮助判断肺部浸润影为感染性或非感染性, 主要包括C 反应蛋白( C-reactive protein,CRP) 、降钙素原( procalcitonin, PCT) 和可溶性髓样细胞触发受体1( soluble triggering receptor expressed onmyeloid cells-1,sTREM-1) 等。
Delirium is an acute cognitive disorder caused by a variety of factors which lead to cerebral cortical dysfunction. At present the studies on the pathophysiology of delirium is still very few. But studies on serum biomarker of delirium can help to elucidate the pathophysiological mechanism of delirium, and the studies are significant for delirium diagnosis, severity classification and prediction of long-term outcome. This review examines three major groups of delirium related serum biomarkers: ① risk markers: those that are present or elevated prior to disease onset, including serum chemistries, genetic markers and so on; ② disease markers: those markers elevate with delirium onset and fall when delirium recovery, including acetylcholine and serum anticholinergic activity, serotonin, serum amino acids, and melatonin, interleukin, C-reactive protein; and ③ end products: those that rise in proportion to the consequences of disease, including S-100ß and neuron specific enolase. The three markers mentioned above are helpful to further investigate the mechanism of delirium.