血清降钙素原水平预测在肝胆外科术后感染的价值

Value of serum procalcitonin level in prediction of infections after hepatobiliary surgery

目的探讨血清降钙素原(PCT)水平在肝胆外科手术后预测感染的价值,以期为应用临床合理应用抗菌药物提供参考性意见。方法选取2013年2月-2015年7月在医院行肝胆外科手术治疗的627例患者,根据患者术后是否发生感染,分为感染组(30例)和非感染组(597例);分别于术后1、3、7d采集患者肘静脉血检测血清PCT水平,并进行组间比较。结果感染组患者术后1、3、7d血清PCT水平均明显高于非感染组(P<0.05);术后1、3、7d血清PCT水平诊断术后感染性并发症发生的ROC曲线下面积(AUC)分别为0.88、0.83、0.86,最佳阈值分别为0.74、0.81、0.70ng/ml;术后1、3、7d血清PCT水平分别以0.74、0.81、0.70ng/ml,诊断术后感染性并发症发生的效能明显优于原标准(0.5、2.0ng/ml)。结论术后监测血清PCT水平,可早期预测感染的发生,术后1、3、7d诊断术后感染性并发症发生的效能较原标准更优。

OBJECTIVE To explore the value of serum procalcitonin（PCT）levels in prediction of infections after hepatobiliary surgery so as to provide guidance for reasonable clinical use of antibiotics.METHODS A total of 627 patients who received surgical procedures in the hepatobiliary surgery department from Feb 2013 to Jul 2015 were enrolled in the study and divided into the infection group with 30 cases and the non-infection group with 597 cases according to the status of postoperative infections.The cubital venous blood specimens were collected on Day 1,3,and 7after the surgery so as to detect the serum PCT levels,and the serum PCT levels were compared between the two groups.RESULTS The levels of serum PCT of the infection group were significantly higher than those of the non-infection group after the surgery for 1,3,and 7days（P〈0.05）.The areas under ROC curve of the serum PCT levels on Day 1,3,and 7after the surgery in diagnosis of the postoperative infections were 0.88,0.83,and 0.86,respectively;the optimal threshold values were 0.74ng/ml,0.81ng/ml,and 0.70ng/ml,respectively.The levels of serum PCT on Day 1,3,and 7after the surgery were 0.74ng/ml,0.81ng/ml,and 0.70ng/ml,respectively.The effectiveness of the serum procalcitonin levels was significantly superior to the original standard in the diagnosis of postoperative infectious complications（0.5,2.0ng/ml）.CONCLUSIONThe postoperative surveillance of the serum PCT level may contribute to the early prediction of the infections,and the effectiveness of the serum PCT level is superior to the original standard on Day 1,3,and 7after the surgery.