胃手术后患者血降钙素原水平对判断术后感染性并发症的意义

The relationship between serum procalcitonin and postoperative infectious complications following gastric surgery

目的 确定胃手术后患者血降钙素原（procalcitonin,PCT）值的影响因素,评估以血PCT值判断胃手术后患者发生感染性并发症的作用.方法 从2011年6月至2013年1月,将非连续的153例行胃手术的患者纳入研究,记录其在手术第1、3、7天的体温、血PCT、外周血白细胞计数及中性粒细胞比例,分析影响术后血PCT值的因素,并分别研究其判断感染性并发症的能力.结果 术后并发症、手术类型和行急诊手术对术后第1天的血PCT值有一定程度的影响,而术后第3天和第7天血PCT值的影响因素均为术后并发症.在排除术前感染病例后,伴有感染性并发症病例的血PCT值在术后第1、3、7天均高于无并发症病例（t=2.92,P＜0.01;t=5.34,P＜0.01;t =4.03,P＜0.05）.血PCT在术后第1、3、7天的受试者工作特征曲线下面积分别为0.89、0.82和0.87,相对应的最佳阈值为0.75、0.84、0.71 ng/ml,其中第1天和第7天的曲线下面积在所有参数中最高.在无并发症组中,术后第1、3、7天的平均血PCT值分别为（0.47 ±0.97）、（0.36±0.50）、（0.23 ±0.24） ng/ml,从术后第1～3天以及术后第3～7天,血PCT值均平均下降55％.结论 无术后并发症的患者血PCT值呈明显下降趋势,而有术后感染性并发症患者的血PCT值明显上升,连续监测血PCT值可以更有效地判断术后感染性并发症的发生.

Objective To analyse the factors that have effects on patients＇ procalcitonin （PCT）level after gastic surgery and to evaluate PCT as a parameter for detection of infectious complications.Methods A total of 153 patients undergoing gastric surgery were included in the study between Jul 2011 and Jan 2013.Temperature and routine blood samples for determining PCT level,neutrophil ratio,white blood cell count were obtained on postoperative days （POD） 1,3,7.Predictive values for each of the markers were examined.Results Postoperative complication,preoperative infection and surgery type affected the PCT level of patients on POD 1.Meanwhile,the independent factor that had influence on PCT level on POD 3 and 7 was postoperative complication.After excluding those patients with preoperative infection,patients with infectious complication exhibited significantly higher PCT levels （t =2.92,P ＜0.01,t =5.34,P ＜0.01,t =4.03,P ＜0.05） on POD 1,3,7 respectively）,neutrophil ratio （on POD 3 and 7） and WBC count （on POD 3） than did those without complication.According to receiver operating characteristic analysis,PCT showed the highest AUC on POD 1,7 （AUC =0.89 and 0.87 respectively）.In the patients without complication,the mean PCT value was （0.47 ± 0.97）,（0.36 ± 0.50）,（0.23 ± 0.24） ng/ml on POD 1,3,7 respectively.The PCT level declined 55％ from POD 1 to POD 3 and from POD 3 to POD 7.Conclusions The serum PCT level of patients without any complication showed a decreasing trend while PCT level of those with infectious complications increased significantly.Continuous monitoring PCT level could serve as a diagnostic tool for the early identification of infectious complication after gastric surgery.