C-反应蛋白检测在快速康复外科治疗胃肠道肿瘤中的意义

Significance of Detection of C-reactive Protein in Fast-track Surgery for Gastrointestinal Tumors

目的探讨C-反应蛋白(CRP)水平在快速康复外科治疗胃肠道肿瘤中的意义。方法经快速康复手术治疗的胃肠道肿瘤患者46例,于术前,术后3 d7、d、9 d空腹取静脉血3 ml,分离血清,检测K+、Na+、Cl-和CRP水平,将出现并发症(感染)为A组10例,未出现并发症(未感染)为B组36例,比较两组上述指标变化;用Logistic回归建立预测模型,并用ROC曲线评价术后第3天患者CRP检测结果对用快速康复理念手术治疗胃肠肿瘤后感染的诊断价值。结果术前和术后各时点K+、Na+无明显变化(P>0.05),Cl-明显降低(P<0.01)。术后各时点CRP水平明显升高(P<0.01)。预测模型为Logit(p)=-2.6391+2.6391X,OR=14.00(P<0.05),以CRP 105 ng/L为临界值,CRP高的患者发生术后感染的危险性是CRP低的患者的14倍;ROC曲线分析显示ROC曲线下面积Az=0.7958。结论术后第3天检测CRP对用快速康复理念手术治疗胃肠肿瘤的感染诊断有中等价值。

Objective To explore significance of detection of C-reactive protein in fast-track surgery（FTS）for gastrointestinal tumors.Methods 46 patients of gastrointestinal tumors treated by fast-track surgery were recruited.Fasting venous blood was collected at preprocedural,third day,seventh day and ninth day at postprocedural and the levels of K＋,Na＋,Cl-and CRP were tested.10 patients with occurred of infection defined as group A,36 patients without occurred of infection defined as group B.The levels of K＋,Na＋,Cl-and CRP were compared between two groups.Logistic regression model was used to construct predict model,ROC curve was used to evaluate the diagnostic value of CRP in the FTS for gastrointestinal tumors.Results The levels of K＋,Na＋ did not change significantly between two groups at each time（P0.05）;the level of Cl-reduced significantly（P0.05）,while level of CRP increased significantly at each time（P0.01）.Logistic regression model was logit（p）=-2.6391＋2.6391X,OR=14.00（P0.05）.The cut-off of CRP level was 105 ng/L and the risk of infection in patients of high level of CRP was 14 times compared to the low level of CRP.The area under curve of ROC curve was Az=0.7958.Conclusion The third day postprocedural of CRP level is of moderate diagnostic value for the gastrointestinal tumors treated by FTS.