摘要
目的评价血清降钙素原（PCT）对胰十二指肠切除术（PD）术后腹腔感染的早期预测及诊断价值。方法回顾性分析2016年4月至2017年4月间哈尔滨医科大学附属第一医院行PD的62例患者的临床资料，记录患者的一般资料及术后情况，检测术前及术后1、3、5 d血清PCT、C-反应蛋白（CRP）水平及白细胞（WBC）计数。根据术后有无腹腔感染分为腹腔感染组（10例）和对照组（52例）。绘制受试者工作特征（ROC）曲线，计算ROC曲线下面积（AUC），确定截断值，比较两组患者的敏感度及特异度。结果腹腔感染组和对照组患者的年龄、性别、BMI、是否合并糖尿病、术前实验室指标、麻醉时间、手术时间、术中出血及输血量、手术方式、有否布朗吻合等差异均无统计学意义，具有可比性。腹腔感染组术后高血糖、切口感染、胰瘘、胆瘘发生率及病死率、术后住院时间、医疗总费用均显著高于对照组，差异有统计学意义（P值均〈0.05）。术前两组患者的PCT、CRP水平及WBC计数的差异均无统计学意义。术后1 d腹腔感染组PCT水平显著高于对照组，差异有统计学意义（P〈0.05）；其预测腹腔感染的敏感度为90%，特异度为75%，显著高于CRP及WBC计数。术后3、5 d PCT、CRP水平及WBC计数对术后腹腔感染的敏感度及特异度差异均无统计学意义，但三者联合诊断的敏感度高达100%和90%，显著高于3个指标单独应用。结论血清PCT水平能够早期预测及诊断PD术后腹腔感染，联合应用PCT、CRP、WBC诊断价值更高。
Objective To evaluate the early predictive and diagnostic value of procalcitonin （PCT） in abdominal infection after pancreatoduodenectomy（PD）.Methods The clinical data of 62 patients with PD in the First Affiliated Hospital of Harbin Medical University from April 2016 to April 2017 were retrospectively analyzed. The general data and postoperative conditions of the patients were recorded. Serum PCT, C-reactive protein （CRP） levels and WBC counts were measured before and 1, 3, and 5 days after surgery. According to the postoperative abdominal infection, the patients were divided into abdominal infection group（n=10） and control group（n=52）. The area under the ROC curve（AUC） was calculated by plotting the receiver operating characteristic （ROC） curve, and the cut-off value was determined to compare the sensitivity and specificity of the two groups of patients.Results There were no significant difference between two groups on age, gender, BMI, diabetes mellitus, preoperative laboratory indicators, anesthetic time, operation time, intraoperative bleeding and blood transfusion, surgical procedures and Braun anastomosis, which were comparable. The incidence of postoperative hyperglycemia, surgical incision infection, pancreatic fistula, biliary fistula, mortality, postoperative hospital stay and total medical costs of abdominal infection group were significantly higher than those of control group （P〈0.05）. There were no significant differences on PCT, CRP, and WBC between the two groups before surgery. The PCT level of the abdominal infection group was significantly higher than that of the control group at the 1st postoperative day and the difference was statistically significant （P〈0.05）. The sensitivity of predicting abdominal infection was 90% and the specificity was 75%, which was significantly higher than those of CRP and WBC. There were no significant differences on the sensitivity and specificity of PCT, CRP and WBC for postoperative abdominal infection at 3 and 5 days after surgery, but the sensitivity of the combined diagnosis was as high as 100% and 90%, significantly higher than 3 indicators alone, respectively.Conclusions Serum PCT level may predict in advance or diagnose early abdominal infection after PD. The combination of PCT, CRP and WBC might be more valuable for the diagnosis of abdominal infection after PD.
作者
李广洲
朱宗文
王水平
左仲强
郭得兴
谭宏涛
孙备
姜洪池
Li Guangzhou;Zhu Zongwen;Wang Shuiping;Zuo Zhongqiang;Guo Dexing;Tan Hongtao;Sun Bei;Jiang Hongchi(Department of Pancreatic and Biliary Surgery,First Affiliated Hospital,Harbin Medical University,Harbin 150001,China)
出处
《中华胰腺病杂志》
CAS
2018年第5期313-317,共5页
Chinese Journal of Pancreatology
基金
黑龙江省青年科学基金（QC20L0124）
黑龙江省教育厅科学技术研究项目（12541290）
