降钙素原、超敏C-反应蛋白及D-二聚体在腹腔感染诊断和预后评估中的价值
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摘要
目的探讨降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)及D-二聚体(D-D)对腹腔感染的早期诊断和预后评估的价值。方法收治的腹腔感染患者180例进行回顾性分析,根据患者治疗后疾病转归情况分为存活组(n=119)和死亡组(n=61),再根据腹水病原菌培养结果将患者分为革兰阳性组(n=78)和革兰阴性组(n=102),另选择50例同期体检正常者为对照组。比较3组间各时期PCT、hs-CRP和D-D水平,分析三者水平变化与的关系。结果对照组、存活组和死亡组各时间点血清PCT、hs-CRP和D-D水平差异有统计学意义(P<0.05);存活组与死亡组各时间点血清PCT、hs-CRP和D-D水平均高于对照组(P<0.05);死亡组各时间点血清PCT、hs-CRP和D-D水平均高于存活组(P<0.05)。入院时,革兰阴性组PCT、hs-CRP水平均显著高于革兰阳隆组(P<0.05),但2组D-D水平差异无统计学意义(P>0.05)。结论血清PCT、hs-CRP和D-D水平能够有效诊断腹腔感染,且对患者预后评估有重要价值,血清PCT、hs-CRP还有助于病原菌的确定,能够为临床抗生素药物的使用提供参考。
Objective To explore the value of calcitonin(PCT),hypersensitive C reactive protein(hs-CRP) and D-dimer(D-D) in the early diagnosis and prognosis evaluation of abdominal infection.Methods The clinical data about 180 patients with abdominal infection who were admitted and treated in our hospital from January 2015 to January 2017 were retrospectively analyzed. The patients were divided into the survival group(n=119) and death group(n=61) according to the prognosis of the patients after the treatment.Moreover the patients were redivided into gram-positive bacteria group(n=78) and gram-negative bacteria group according to the results of the pathogenic bacteria culture in ascites,and the other 50 subjects who underwent physical examination at the same period were enrolled as control group.The levels of PCT,hs-CRP and D-D were detected and compared among groups,and the correlation among the three indexes was analyzed.Results There were significant differences in the serum levels of PCT,hs-CRP and D-D among the the three groups(P<0.05).The serum levels of PCT,hs-CRP and D-D in survival group and dead group in different time points were significantly higher than those in control group(P<0.05),moreover,which in death group were significantly higher than those in survival group(P<0.05).On admission the levels of PCT and hs-CRP in gram-negative bacteria group were significantly higher than those in gram-positive bacteria group(P<0.05),but there were no significant differences in the levels of D-D between the two groups(P>0.05).Conclusion The detection of serum levels of PCT,hs-CRP and D-D can effectively diagnose the abdominal infection,and it is of great value to the prognosis evaluation of patients.The serum PCT and hs-CRP are also helpful for the determination of the pathogenic bacteria,which can provide reference for the use of clinical antibiotic drugs.
Objective To explore the value of calcitonin(PCT),hypersensitive C reactive protein(hs-CRP) and D-dimer(D-D) in the early diagnosis and prognosis evaluation of abdominal infection.Methods The clinical data about 180 patients with abdominal infection who were admitted and treated in our hospital from January 2015 to January 2017 were retrospectively analyzed. The patients were divided into the survival group(n=119) and death group(n=61) according to the prognosis of the patients after the treatment.Moreover the patients were redivided into gram-positive bacteria group(n=78) and gram-negative bacteria group according to the results of the pathogenic bacteria culture in ascites,and the other 50 subjects who underwent physical examination at the same period were enrolled as control group.The levels of PCT,hs-CRP and D-D were detected and compared among groups,and the correlation among the three indexes was analyzed.Results There were significant differences in the serum levels of PCT,hs-CRP and D-D among the the three groups(P<0.05).The serum levels of PCT,hs-CRP and D-D in survival group and dead group in different time points were significantly higher than those in control group(P<0.05),moreover,which in death group were significantly higher than those in survival group(P<0.05).On admission the levels of PCT and hs-CRP in gram-negative bacteria group were significantly higher than those in gram-positive bacteria group(P<0.05),but there were no significant differences in the levels of D-D between the two groups(P>0.05).Conclusion The detection of serum levels of PCT,hs-CRP and D-D can effectively diagnose the abdominal infection,and it is of great value to the prognosis evaluation of patients.The serum PCT and hs-CRP are also helpful for the determination of the pathogenic bacteria,which can provide reference for the use of clinical antibiotic drugs.
引文
1 丁佳,皋源.PCT清除率与△SOFA在复杂腹腔感染中的预测价值.实用医学杂志,2016,32:4034-4037.
2 吴新军,王雷,秦玉刚,等.腹腔感染与血清降钙素原水平变化的相关性分析.中华医院感染学杂志,2013,23:3418-3420.
3 张宗祥,金弢,方迪龙,等.外科腹腔感染患者PCT与TNF-α 及CRP和IL-6水平与感染程度的研究.中华医院感染学杂志,2017,27:4712-4715.
4 汪运节,韩江,陈益鸣,等.血清乳酸及降钙素原在腹腔感染中的临床意义.海南医学,2015,26:206-207,208.
5 王苏梦,唐海霞,印中鹏,等.血浆抗凝血酶Ⅲ和血清降钙素原检测在腹腔感染诊断和预后中的临床价值.现代检验医学杂志,2016,31:22-25.
6 任华建,王革非,顾国胜,等.降钙素原对肠瘘患者确定性手术后腹腔感染的预测价值.中华胃肠外科杂志,2017,20:524-529.
7 金卫,张晓燕,杜江,等.降钙素原和白介素-6在老年复杂性腹腔感染患者预后评估中的意义.老年医学与保健,2017,23:9-11,18.
8 李小鹏,王亮,饶希,等.降钙素原、C-反应蛋白检测在肝衰竭合并腹腔感染中的临床价值.南昌大学学报(医学版),2017,57:33-35.
9 夏恒,陈福森,孙玲玲,等.C-反应蛋白对普外科患者手术后腹腔感染性并发症的预测效果.中华医院感染学杂志,2017,27:2539-2542.
10 宋笑飞,宋玉成,袁远,等.白细胞介素-35在腹腔感染导致脓毒血症中的诊断价值.中华实验外科杂志,2017,34:1562-1564.
11 吴宗劲,华海湖.血清降钙素水平检测在腹腔感染诊治中的应用价值.内科,2014,9:281-282,316.
12 吴延雷,汪晓英,方正,等.降钙素原与 C-反应蛋白和白细胞计数在新生儿感染性疾病诊断应用.中华医院感染学杂志,2014,24:6063-6065.
13 朱丽坤,温洁新.Hs-CRP与PCT在新生儿败血症早期诊断及病情评估中的应用.实用医学杂志,2016,32:1002-1003.
14 王大伟,郅红蕾,张庆等.降钙素原联合D-二聚体检测判断急诊感染患者病情的临床意义.中华医院感染学杂志,2017,27:758-761.
15 侯枫林,汪为刚,孙燕,等.血清D-二聚体联合降钙素原对急诊感染的临床价值.检验医学与临床,2016,13:529-530.
2 吴新军,王雷,秦玉刚,等.腹腔感染与血清降钙素原水平变化的相关性分析.中华医院感染学杂志,2013,23:3418-3420.
3 张宗祥,金弢,方迪龙,等.外科腹腔感染患者PCT与TNF-α 及CRP和IL-6水平与感染程度的研究.中华医院感染学杂志,2017,27:4712-4715.
4 汪运节,韩江,陈益鸣,等.血清乳酸及降钙素原在腹腔感染中的临床意义.海南医学,2015,26:206-207,208.
5 王苏梦,唐海霞,印中鹏,等.血浆抗凝血酶Ⅲ和血清降钙素原检测在腹腔感染诊断和预后中的临床价值.现代检验医学杂志,2016,31:22-25.
6 任华建,王革非,顾国胜,等.降钙素原对肠瘘患者确定性手术后腹腔感染的预测价值.中华胃肠外科杂志,2017,20:524-529.
7 金卫,张晓燕,杜江,等.降钙素原和白介素-6在老年复杂性腹腔感染患者预后评估中的意义.老年医学与保健,2017,23:9-11,18.
8 李小鹏,王亮,饶希,等.降钙素原、C-反应蛋白检测在肝衰竭合并腹腔感染中的临床价值.南昌大学学报(医学版),2017,57:33-35.
9 夏恒,陈福森,孙玲玲,等.C-反应蛋白对普外科患者手术后腹腔感染性并发症的预测效果.中华医院感染学杂志,2017,27:2539-2542.
10 宋笑飞,宋玉成,袁远,等.白细胞介素-35在腹腔感染导致脓毒血症中的诊断价值.中华实验外科杂志,2017,34:1562-1564.
11 吴宗劲,华海湖.血清降钙素水平检测在腹腔感染诊治中的应用价值.内科,2014,9:281-282,316.
12 吴延雷,汪晓英,方正,等.降钙素原与 C-反应蛋白和白细胞计数在新生儿感染性疾病诊断应用.中华医院感染学杂志,2014,24:6063-6065.
13 朱丽坤,温洁新.Hs-CRP与PCT在新生儿败血症早期诊断及病情评估中的应用.实用医学杂志,2016,32:1002-1003.
14 王大伟,郅红蕾,张庆等.降钙素原联合D-二聚体检测判断急诊感染患者病情的临床意义.中华医院感染学杂志,2017,27:758-761.
15 侯枫林,汪为刚,孙燕,等.血清D-二聚体联合降钙素原对急诊感染的临床价值.检验医学与临床,2016,13:529-530.