血清降钙素原在肝胆外科术后诊断细菌感染的临床价值

Clinical value of serum procalcitonin in the diagnosis of bacterial infection after hepatobiliary surgery

目的探讨血清降钙素原(PCT)联合白细胞(WBC)、中性粒细胞百分比(NE%)在肝胆外科术后诊断细菌感染模式的临床价值。方法选取本院2018年7月-2020年6月483份肝胆外科手术病例,记录术后3 h-12 h PCT、WBC、NE%值,并根据相关诊疗指南判断是否感染,利用方差分析比较感染和未感染病例PCT、WBC、NE%的差异性,采用受试者工作特征曲线(ROC曲线)评估诊断效能和截值;通过截值将上述病例分组,并运用统计学方法验证预测感染率与实际感染率的差异。结果(1)方差分析显示,术后感染和未感染患者PCT、WBC、NE%水平存在显著性差异(P<0.05);(2)术后PCT、WBC、NE%的ROC曲线下面积分别为0.858、0.776、0.784均有较好的预测效能,其截值分别为1.030 ng/ml、13.98×10^(9)/L、85.30%;(3)当PCT<1.030 ng/ml时,根据截值分组的预测感染率与实际感染率有显著性差异(P<0.05),没有临床意义;当PCT>1.030 ng/ml时,根据截值分组的预测感染率与实际感染率无显著性差异(P>0.05),有临床意义。结论血清PCT的截值筛选术后感染人群有一定的价值,同时联合WBC、NE%等指标对肝胆外科术后诊断感染及治疗有良好的指导意义,PCT>1.03 ng/ml可作为诊断术后细菌感染的诊断截点。

Objective To investigate the clinical value of serum Procalcitonin(PCT),white blood cell(WBC)and neutrophil percentage(NE%)in diagnosis of bacterial infection pattern after hepatobiliary surgery.Methods 483 cases of hepatobiliary surgery were selected in our hospital from July 2018 to June 2020.The PCT,WBC,and NE%were recorded from 3 to 12 hours after operation,and according to the relevant diagnosis and treatment guidelines to determine whether infection.Variance analysis was used to compare the difference of PCT,WBC,and NE%between infected and uninfected patients.Receiver operating characteristic curve was used to evaluate the diagnostic efficacy and cut-off value.The above cases were grouped by cut-off value,and the difference between the predicted and actual infection rate was verified by statistical method.Results(1)The variance analysis showed that there were significant differences in the levels ofWBC and NE%between postoperative infected and uninfected patients(P<0.05);(2)The area under ROC curve of 0.858,0.776,and 0.784 for PCT,WBC,and NE%,respectively,had good predictive efficacy.The cut off values were 1.030 ng/ml,13.98×10^(9)/L and 85.30%,respectively.(3)When PCT<1.030 ng/ml,there was significant difference between the predicted infection rate and the actual infection rate grouped according to the cut-off value(P<0.05),but there was no clinical significance.When PCT>1.030 ng/ml,there was no significant difference between the predicted infection rate and the actual infection rate grouped according to the cut-off value(P>0.05),but it had clinical significance.Conclusion The cut-off value of serum PCT has certain value in screening the patients with postoperative infection,and the combination ofWBC and NE%has a good guiding significance for the diagnosis and treatment of postoperative infection in hepatobiliary surgery,PCT>1.03 ng/ml can be used as the cut-off point for the diagnosis of postoperative bacterial infection.