血清降钙素原在EST术后反流性胆管炎胆汁病原菌构成改变中的表达及临床意义

The expression and clinical significance of serum pocalcitonin in the EST postoperative reflux cholangitis,which biliary pathogenic bacteria composition changed

目的了解经内镜乳头括约肌切开术(EST)后反流性胆管炎患者胆汁病原菌的分布及抗菌药物的敏感性,并重点探讨血清降钙素原(PCT)浓度在行EST后反流性胆管炎患者胆汁病原菌构成改变中的表达及临床意义。方法回顾性分析227例在龙岗区坪地人民医院行EST后发热的患者,对其中85例确诊为EST后反流性胆管炎患者的胆汁标本进行细菌培养及药敏实验,并检测所有行EST后发热患者的血清PCT浓度、白细胞(WBC)总数及C-反应蛋白(CRP)浓度。结果 85例行EST后反流性胆管炎患者共检测出病原菌93株,其中革兰阴性杆菌65株(69.9%)、革兰阳性菌25株(26.9%)、真菌3株(3.2%)。药敏结果显示,病原菌对β-内酰胺类复合制剂、碳青酶烯类、三、四代头孢菌素、氨基糖苷类抗菌药物敏感性高,对喹诺酮类、青霉素类、磺胺类抗菌药物敏感性低。PCT、WBC、CRP检测结果显示,PCT检测最佳阳性临界值为0.25 ng/ml,此时敏感度为95.2%,特异度为66.7%;WBC检测最佳诊断临界值为10.09×109/L,此时敏感度为81.0%,特异度为50.0%;CRP以77.35 mg/L为最佳阳性临界值,此时敏感度为81.0%,特异度58.3%。结论血清降钙素检测是行EST后反流性胆管炎诊断的有效指标,EST后反流性胆管炎胆汁病原菌种类繁多,临床应依据药敏结果选择合适的抗菌药物。

Objective To survey the distribution of the pathogenic microorganisms in biles collected from the EST postoperative reflux cholangitis patients and their susceptibility to antibiotics. Meanwhile, to discuss the expression and clinical significance of serum procalcitonin level in the EST postoperative reflux cholangitis. Methods Two hundred and twenty-seven eases who were EST postoperative fever patients were retrospectively analyzed. Eighty-five patients were diagnosed as EST postoperative reflux cholangltis patients and their bile specimens were cultured and tested for an- tibiotics susceptibility. The serum procaleitonin level, leucocyte counts, C-reactive protein concentration were deter- mined in all EST postoperative fever patients. Results Ninety-three strains pathogenic bacteria were detected in 85 pa- tients, including the Gram-negative bacilli 65 strains （69.9%） , Gram-positive bacteria 25 strains （26.9%） and fun- gus 3 strains （3.2%）. Drug susceptibility results showed that the pathogenic microorganisms were more sensitive to an- tibiotic/plactamase inhibitor combination, carbopenems, the third and fourth generation cephalosporins and aminoglyco- sides antibiotics, while less sensitive to fluoroquinolones, penicillins and sulfa antibacterial drugs. The results of PCT, WBC, CRP detection showed that taking 0.25 ng/ml as the positive threshold of SCT, the sensitivity and the specificity were 95.2% and 66.7% , respectively. When WBC of 10.09 x 109/L was taken as the positive threshold, the sensitivi- ty and the specificity were 81.0% and 50.0% , respectively. If neutrophilic granulocyte of 77.35 mg/L was regarded as the positive threshold, the sensitivity and the specificity were 81.0% and 58.3% , respectively. Conclusion Determi- nation of serum procalcitonin level can be used as an effective index for the EST postoperative reflux cholangitis. The pathogenic microorganisms in the EST postoperative reflux cholangitis patients are very various, doctors should pay more attention to analyze the bacterial resistance profile and use the antibiotics properly.