Biomarker bei infektiösen und nicht infektiösen Lungenerkrankungen außer Malignome

Zusammenfassung

Biomarker haben einen festen Stellenwert in der Medizin und unterstützen in der Diagnosestellung, sie weisen eine für bestimmte Erkrankungen prädiktive Wertigkeit auf, helfen u. U. besser die eingeleitete Therapie zu steuern und den klinischen Verlauf der betroffenen Patienten zu überwachen. Allerdings ist nur ein kleiner Teil der Vielzahl an untersuchten Markern für die Betreuung pneumologischer Patienten von verlässlichem Wert, wie z. B. Procalcitonin in der Therapiesteuerung von Patienten mit einer Pneumonie oder einer Sepsis, der Alpha-1-Antitrypsin-Serumspiegel bei Alpha-1-Antitrypsin-Mangelpatienten, die D-Dimere in der Diagnostik einer Lungenembolie oder einer Venenthrombose, Stickstoffmonoxid beim Asthma oder die Keimisolation im Sputum zur antibiogrammgerechten Antibiotikatherapie bei der chronisch-obstruktiven Lungenerkrankung oder der Pneumonie. Der qualitative Nachweis und die Quantifizierung von Markern im Atemkondensat oder der Nachweis von Molekülen in der Ausatemluft sind neue, noch nicht etablierte Verfahren, die möglicherweise in der Zukunft helfen werden, bestimmte Erkrankungen besser zu diagnostizieren oder zu therapieren. Grundsätzlich haben Biomarker, zusammen mit den übrigen uns zur Verfügung stehenden Verfahren, nur einen unterstützenden, nichtsdestotrotz aber einen wichtigen praktischen Wert. In dieser Übersicht wird anhand von neueren Studienergebnissen die Wertigkeit von Biomarkern bei nicht malignen Erkrankungen der Atemwege und der Lungen beleuchtet.

Abstract

Biological markers in various compartments of the human body have demonstrated potential value in diagnosis, prediction, guidance of therapy as well as in monitoring the clinical course of diseases of the airways and the lung. But only certain surrogate parameters are from clinical value, such as procalcitonin in pneumonia and sepsis, alpha-1-antitrypsin to diagnose alpha-1-antitrypsin deficiency, D-Dimere to detect emboli, nitric oxide in exhaled air in asthma, or isolation of germs from sputum to guide antibiotic treatment. Quantification of numerous markers in exhaled breath condensate or the detection of compounds in exhaled air are more recent attempts to further elucidate those biomarkers for clinical use. In general, biomarkers have an important supportive value in addition to routine diagnostic methods. The article reviews recent data regarding the usefulness of markers in non-malignant pulmonary diseases.

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