血浆PCT和CRP变化与胆道术后感染相关性及治疗的研究
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摘要
目的研究胆道手术术前术后血浆PCT、CRP变化与术后感染的相关性,指导胆道手术术后监护与感染后治疗。方法选择2017年1月至2018年1月入住海军军医大学附属东方肝胆外科医院ICU的胆道手术术后患者100例,在术前、术后抽取外周血检测血浆PCT、CRP水平,术中留取胆汁,进行微生物培养,根据胆汁培养结果分为两组:胆汁培养阳性组和胆汁培养阴性组,比较每组术前术后血浆PCT、CRP水平有无差异,以及两组间血浆PCT、CRP术前术后水平有无差异。结果每组患者血浆PCT、CRP的术前术后之间水平差异有统计学意义(P<0.05),且胆汁培养阳性组的差异更显著,具有统计学意义(P<0.05)。并且血浆PCT术前术后变化具有更高的特异性和敏感性,便于胆道术后感染的诊断。结论胆道术后患者血浆PCT、CRP水平均高于术前水平,且胆汁培养阳性组患者术后血浆PCT、CRP水平上升幅度更明显,血浆PCT、CRP水平的变化有助于胆道术后感染严重程度的诊断与指导治疗。
Objective To investigate the prognostic value of dynamic monitoring of blood PCT and CRP level in the infections after biliary surgery and the clinical significance. Methods 100 patients were collected in our hospital ICU from January 2017 to January 2018,Blood samples for testing PCT, CRP level were taken on one day before surgery and on one day after surgery. In the operation, bile cultures were collected, According to the results of bile culture, individed into bile culture positive group and bile culture negative group, compared the plasma PCT, CRP level, between each group. Results ①The levels of plasma PCT and plasma CRP, the differences in each group were statistically significant(P<0.05), and the difference in bile culture positive group was statistically significant(P<0.05); ②The specificity and sensitivity of PCT were higher than the CRP in the diagnosis of biliary infection,helpfulin the evalution of the severity of biliary infection and the therapy of biliary infection. Conclusion The plasma PCT, CRP levels showed an upward trend after biliary surgery. The PCT and CRP levels in the bile cultrues-positive group were significantly higher than bile culture-negative group. Dynamic monitoring of PCT levels can be helpful in the evalution of the severity of biliary infection and the therapy of biliary infection.
Objective To investigate the prognostic value of dynamic monitoring of blood PCT and CRP level in the infections after biliary surgery and the clinical significance. Methods 100 patients were collected in our hospital ICU from January 2017 to January 2018,Blood samples for testing PCT, CRP level were taken on one day before surgery and on one day after surgery. In the operation, bile cultures were collected, According to the results of bile culture, individed into bile culture positive group and bile culture negative group, compared the plasma PCT, CRP level, between each group. Results ①The levels of plasma PCT and plasma CRP, the differences in each group were statistically significant(P<0.05), and the difference in bile culture positive group was statistically significant(P<0.05); ②The specificity and sensitivity of PCT were higher than the CRP in the diagnosis of biliary infection,helpfulin the evalution of the severity of biliary infection and the therapy of biliary infection. Conclusion The plasma PCT, CRP levels showed an upward trend after biliary surgery. The PCT and CRP levels in the bile cultrues-positive group were significantly higher than bile culture-negative group. Dynamic monitoring of PCT levels can be helpful in the evalution of the severity of biliary infection and the therapy of biliary infection.
引文
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[10] Morgenthaler NG, Struck J, Chanterelle Y. et al. P Luclion of procalcitonin(PCT)in non-lhymidal afu*r LPS injcclion[J]. Horm MetaJ Res, 2003, 35(5):290-295.
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[12] Gao HF, Chen W, Jun-Li GE. Diagnostic value of joint determination of CRP, IL-6 and PCT in blood stream infection[J]. Cytogenetics&Cell Genetics,2000,91(1-4):199-203.
[13]赵秋霞,毛磊,刘恒亮,等.慢性心力衰竭患者并发重症感染性肺炎免疫指标变化的临床意义[J].中华医院感染学杂志,2016,26(13):2951-2953.
[14]金建云,常晓.降钙素原及白细胞介素-6在急性胰腺炎患者早期感染诊断及预后的意义[J].中华医院感染学杂志,2012,22(19):4258-4260.
[2]孙永太.降钙素原联合C反应蛋白检测在细菌感染中的价值分析[J].中国医药指南,2018,16(9):107.
[3]金胜鑫,石海矾,李伟,等.血清降钙素原与超敏C反应蛋白及白介素6在新生儿早期感染中的诊断价值[J].中华医院感染学杂志,2013,23(7):1600-1601.
[4]胡韶山,于启霞.降钙素原在细菌感染中的变化及意义[J].中国实用医药,2012,7(27):139-140.
[5]中华医学会外科学分会胆道外科学组.急性胆道系统感染的诊断和治疗指南(2011版)[D].中华消化外科杂志,2011,10(1):9-13.
[6] Whang KT, Vath SD, Becker KL, et al. Procalcitonin and proinflammatory cytokine interactions in sepsis[J]. Shock(Augusta Ga), 2000,14(1):73-78.
[7] Nijsten MWN, Olinga P, de Vries EGE, et al. Procalcitonin behaves as a fast responding acute phase protein in vivo and in vitro[J]. Critical care medicine, 2000,28(2):458-461.
[8] Wiedermann FJ. Kaneider N, fer F, et al. Migration of human monocytes in response linK-calcitonin[J].Crit Care Med, 2002,30(5):1112-1117.
[9] Hoffman C, TotzJce C, SciHel M, et al. In villain modulation of inducible nitric oxide synthase gene expression and nitric oxide synthesis by procalcitonin[J]. Crit Care Med, 2001,29(1):112-126.
[10] Morgenthaler NG, Struck J, Chanterelle Y. et al. P Luclion of procalcitonin(PCT)in non-lhymidal afu*r LPS injcclion[J]. Horm MetaJ Res, 2003, 35(5):290-295.
[11] van Nieuwkoop C, Bonten TN, van't Wout JW, et al.Procalcitonin reflects bacteremia and bacterial load in urosepsis syndrome:a prospective observational study[R]. Crit Care, 2010,14(6):206.
[12] Gao HF, Chen W, Jun-Li GE. Diagnostic value of joint determination of CRP, IL-6 and PCT in blood stream infection[J]. Cytogenetics&Cell Genetics,2000,91(1-4):199-203.
[13]赵秋霞,毛磊,刘恒亮,等.慢性心力衰竭患者并发重症感染性肺炎免疫指标变化的临床意义[J].中华医院感染学杂志,2016,26(13):2951-2953.
[14]金建云,常晓.降钙素原及白细胞介素-6在急性胰腺炎患者早期感染诊断及预后的意义[J].中华医院感染学杂志,2012,22(19):4258-4260.