PCT、CRP、WBC检测预警经皮肾术后感染性发热的临床意义

Clinical significance of PCT,CRP,WBC count as predictors in postoperative with infectious fever after percutaneous nephroslithotomy

目的探讨术后早期监测血清降钙素原（PCT）、C-反应蛋白（CRP）及白细胞计数（WBC）对于预警经皮肾镜碎石（PCNL）术后感染性发热的临床意义。方法回顾性分析我科2013年12月至2015年6月收治的行PCNL术合并术后发热患者共118例,根据体温变化和细菌培养结果分为观察组（术后24h内体温≥38.5℃和/或尿细菌培养阳性）58例,对照组（术后24h内体温37.4-38.5℃）60例,分析两组患者术前、术后6h内所检测的血清PCT、CRP及WBC计数水平,三者对感染性发热的预诊断效能釆用受试者工作特征曲线（ROC曲线）。结果观察组术后6h内三者水平均显著高于对照组（P〈0.01）,对3种血清学诊断指标的预诊断效能进行ROC曲线分析,结果显示PCT的AUC最大,为0.915,其对应各指标的截断点中PCT的特异性和灵敏度最高分别为86.2%和96.7%。结论 PCT是感染性发热预诊断的良好指标,CRP、WBC计数的早期诊断效能有限。

Objective To explore the clinical significance of plasma procalcitonin（PCT）and C-reactive protein（CRP）,white blood cell count（WBC）as predictors in postoperative with infectious fever after percutaneous nephroslithotomy.Methods The preoperative and postoperative（within6hours after PCNL）records of PCT,CRP and WBC of 118 patients respectively who underwent PCNL between December 2013 and June 2015 were retrospectively reviewed.All patients were divided into two groups：58cases in observation group were diagnosed as temperature was 38.5℃or higher within 24 hours after surgery and/or positive results in germiculture in urine according to the temperature change and the germiculture,and the others 60 cases in the control group whose postoperative body temperature between 37.4℃ and 38.5℃.And receiver operating characteristic（ROC）curve was used to evaluate the serum PCT,CRP and WBC count level,infectious fever.Results The levels of postoperative PCT,CRP and WBC within 6hours after PCNL in observation group were higher than control group（P〈0.01）.The ROC curve showed that the area under the ROC curve（AUC）of PCT was larger than CRP and WBC（AUC-PCT：0.915）,the corresponding to each index of the truncation point the highest sensitivity and specificity of the PCT were 86.2%and 96.7%respectively.Conclusion PCT is a useful warring marker for infectious fever,and CRP,WBC count of early diagnosis efficiency is limited.