降钙素原对体外循环术后患者预后评估的价值研究

Prognostic value of procalcitonin in patients after cardiopulmonary bypass operation

目的通过连续监测体外循环（CPB）心脏术后患者的血清降钙素原（PCT）水平,对PCT的变化规律进行观察和分析,探讨用PCT作为评估CPB患者的预后辅助工具的可行性。方法收集2013年11月1日至2014年11月30日入住该院心脏重症监护病房（CCU）行CPB心脏手术后121例患者的临床资料,按照纽约心脏病学会（NYHA）分级标准对术后患者出院或病情转归时的心功能进行分级,将患者分为NYHAⅡ级（A组）、NYHAⅢ级（B组）、NYHAⅣ级（C组）,分别测定术前（T0）、手术结束（T）、术后4h（T4h）、术后24h（T1d）、术后48h（T2d）、术后72h（T3d）及术后7d（T7d）7个不同时间点的PCT,对其变化规律及相关性进行分析,并绘制受试者工作特征（ROC）曲线。结果 PCT于CPB结束后开始升高,48~72h达到高峰,但3组在24h之前差异无统计学意义（P〉0.05）。而C组在3d和7d的PCT水平明显高于A组患者（P〈0.05）。Pearson相关分析提示第7天的PCT与组别呈正相关,相关程度最好。用PCT评估CPB术后患者预后时的ROC曲线以第7天面积最大,为0.926,灵敏度及特异度可分别达到91.4%及93.7%。结论 PCT是一种灵敏度和特异度极佳的CPB患者预后参考指标,血浆PCT的检测有助于临床鉴别心脏术后患者有无并发症的发生,可以作为常规临床检测指标来判断CPB患者的预后。

Objective To observe and analyze the change rule of procalcitonin（PCT）level in patients after cardiopulmonary bypass（CPB）operation by means of continuously monitoring PCT,and discuss the feasibility of using PCT as assistant tool to evaluate the prognosis of patients with CPB.Methods Data of 121 patients received cardiac surgery with cardiopulmonary bypass（CPB）in Intensive Care Unit（CCU）of the First Affiliated Hospital of Dalian Medical University from November 1,2013 to November 30,2014 were collected.After surgery,according to the New York heart association（NYHA）classification standard,the patient′s hearts function were subdivided as NYHAⅡ grade（A group）,NYHA Ⅲ grade（B group）and NYHA Ⅳgrade（C group）.PCT level were measured in the plasma at seven different time point,including before operation（T0）,the end of surgery（T）and postoperative4h（T4h）,24h（T1d）,48h（T2d）,72h（T3d）and 7d（T7d）after surgery.Analyzed the pattern and correlation of their changes,and draw the receiver operating characteristic（ROC）curve.Results The level of PCT increased after CPB operation,reached its peak level between 48-72 hafter the surgery.But there were no statistically significant difference among three subgroups compared with in less than 24h（P〉0.05）.The levels of PCT in patients of C group at 48-72 hafter operation were significantly higher than those in patients of A group（P〈0.05）.Pearson correlation analysis showed the level of PCT in 7dwas most significantly positive correlated with classification.The largest area under of ROCcurve was 0.926 at the seventh day after operation,the sensitivity and specificity were 91.4%and 93.7%respectively.Conclusion Plasma PCT is an excellently specific and sensitive reference index of the prognosis of patients with CPB.PCT detection will help clinical identification of cardiac surgery patients with or without complications.It could be used as a routine clinical examination marker to judge the prognosis of patients with CPB.