血清降钙素原对急性胆管炎病情早期诊断及预后评估的临床价值

The clinical value of serum procalcitonin in the early diagnosis and prognosis of acute cholangitis

目的:探讨血清降钙素原(PCT)较传统炎症标志物对急性胆管炎早期诊断、严重程度分级及预后的临床价值。方法:将90例急性胆管炎患者分为轻度急性胆管炎组(n=46)、中度急性胆管炎组(n=32)和重度急性胆管炎组(n=12),通过检测3组患者血清PCT、白细胞计数(WBC)、C-反应蛋白(CRP)水平,绘制受试者工作特征曲线(ROC)来比较PCT与传统炎性指标对于急性胆管炎早期诊断、危险分级的能力,并且对PCT与序贯器官衰竭评分(SOFA)、WBC、CRP进行双变量相关性分析。结果:3组患者PCT、WBC、CRP、SOFA评分随病情严重程度升高而升高,差异有统计学意义(P<0.01)。ROC曲线分析,重度急性胆管炎时,PCT曲线下面积(AUC)为0.90(95%CI:0.85~0.96),明显高于WBC 0.62(95%CI:0.48~0.76)、CRP 0.70(95%CI:0.60~0.80),PCT对于重度急性胆管炎而言其截断值为2.2ng/ml(灵敏度97%、特异度73%),中度胆管炎为0.9ng/ml(灵敏度68%、特异度0.69%)。双变量相关性分析显示,PCT与SOFA评分、WBC呈明显正相关(r=0.513,P=0.007;r=0.215,P=0.034),而与CRP无明显相关性(r=0.099;P=0.175)。结论:PCT对于急性胆管炎的早期诊断价值高于WBC、CRP等传统标志物,具有高特异性和高敏感性等优点,且有助于临床医师对急性胆管炎严重程度及预后的评估。

Objective：To investigate the clinical value of serum procalcitonin（PCT）in the early diagnosis,sever- ity grading and prognosis of acute cholangitis compared with traditional inflammatory markers. Method：Ninety pa- tients with acute cholangitis were divided into mild acute cholangitis group （n= 46）, moderate acute cholangitis group （n=32） and severe acute cholangitis group （n=12）. Serum levels of PCT,white blood cell count（WBC）, and C-reactive protein（CRP） were measured. Receive operating characteristic curve（ROC curve）was used to com- pare the ability of PCT and traditional inflammatory markers in the early diagnosisand risk stratification of acute cholangitis,and to analyze the correlation between PCT and sequential organ failure score（SOFA）, WBC,CRP. Re- sult：PCT.WBC,CRP,SOFA score in the three groups of patient increased with the severity of the disease, the difference was statistically significant （P〈0.01）. Analysis of ROC curve displayed that area under curve （AUC）of PCT in severe acute cholangitis was 0.90 （95 % CI： O. 85 ~0.96）, which was significantly higher than WBC 0.62 （95 %CI： O. 48- 0. 76）, CRP 0. 70 （95 ~ CI： O. 60 ~ 0. 80 ）, The cut-off value of PCT, in terms of severe acute cholangitis, was 2.2 ng/ml（sensitivity 97% ;specificity 73 %）, and in moderate acute cholangitis, it was 0.9ng/ml （sensitivity 68% -specificity 69 %）o Bivariate correlation analysis showed that PCT was positively correlated with SOFA score and WBC（r= 0.513, P = 0. 007 r= 0.215, P = 0. 034）, and there was no correlation between PCT and CRP（r= 0. 099~P= 0. 175）. Conclusion：The value of PCT for the early diagnosis of acute cholangitis is higher than that of WBC, CRP and other traditional inflammatory markers, with high specificity and high sensibility. And it can help the clinicians to evaluate the severity and prognosis of acute cholangitis.