降钙素原值与体外循环术后炎症反应严重程度的相关性研究

Plasma procalcitonin and severity of systemic inflammatory response after cardiopulmonary bypass

目的体外循环(cardiopulmonary bypass,CPB)下心脏手术可诱发全身炎症反应,降钙素原(Procalcitonin,PCT)作为鉴别感染性和非感染性全身炎症反应的工具已得到广泛应用,文中旨在探讨PCT在预测CPB术后全身炎症反应严重程度中的意义。方法统计2011年6月至2011年10月接受心脏瓣膜置换手术部分患者80例,按术后全身性炎性反应综合征(sys-temic inflammatory response syndrome,SIRS)的严重程度作为分组标准,并于术前清晨8∶00(T0),术后8h(T8h),术后1-7 d(T1-T7),测取血浆IL-6、PCT、CRP的浓度。分别对其变化规律及相关性进行观察和分析。结果重症SIRS组PCT在T8h-T4较轻症SIRS组有统计学意义(P<0.05),尤其在T8h-T3上差异极显著(P<0.01),而C反应蛋白(C reaction protein,CRP)在T3-T7较轻症SIRS组有统计学意义(P<0.05),IL-6在各对应时间点上差异均无统计学意义(P>0.05)。结论与CRP和IL-6比较,PCT能更早、更显著地在CPB后重症SIRS的患者血浆中表达,可能是一种更好的预警指标。

Objective Cardiac surgery with cardiopulmonary bypass （CPB） can evoke systemic inflammatory response syn- drome （SIRS）. Procalcitonin （PCT） is widely used for the differential diagnosis of infectious or non-infectious systemic inflammatory re- sponse. This article aimed to investigate the value of PCT in predicting the degree of SIRS after CPB. Methods We included in this study 80 patients undergoing valve replacement, who were divided the into two groups according to the severity of SIRS. We determined the concentrations of PCT, IL-6 and CRP in the plasma before operation （ TO ）, 8 hours after surgery （Ts h ） and 1 to 7 days after surgery （T1 - T7 ）, and analyzed the pattern and correlation of their changes. Results After surgery, the PCT level exhibited a significant ele- vation from Ts h to T4 （P 〈 0.05）, extremely significant from Ts h to T3 （ P 〈 0.01 ） in the severe SIRS group as compared with the mild SIRS group, the CRP level was significantly higher from T3 to T7 （P 〈 0.05） in the former than in the latter, while the IL-6 level showed no statistically significant difference between the two groups （P 〉 O. 05 ）. Conclusion Compared with CRP and IL-6, PCT expresses earlier and more significantly in the plasma of the patients with severe SIRS, which suggests that it might be a good predicting marker.