心脏术后降钙素原变化的临床意义

Clinical significance of the changes of procalcitonin in patients after cardiac surgery

目的探讨心脏术后非感染因素降钙素原（PCT）变化的临床意义。方法选取择期行心脏直视手术的成年患者80例，根据是否采取体外循环（CPB）分为CPB组和非CPB组，检测术前、术后即刻及术后12、36、60 h的PCT、C-反应蛋白（CRP）、白细胞计数（WBC）值，并记录开胸时间，对所有数据进行统计学分析。结果两组患者在术后即刻及术后12、36、60 h的PCT、CRP水平均高于术前（P均〈0.05）。CPB组术后PCT、CRP达高峰值时间早于非CPB组。CPB组术后即刻及术后12 h PCT水平高于非CPB组（P〈0.05）。与术前相比，心脏手术后12、36和60 h的WBC值明显升高（P〈0.05）。CPB组术后WBC值均高于非CPB组，在术后36、60 h时比较差异有统计学意义（P〈0.05）。心脏手术开胸时间与PCT水平在术后即刻及术后12、36 h均有相关性，相关系数分别为0.414，0.489，0.432，P均〈0.05。结论PCT不仅仅是反映全身感染的敏感、特异指标，而且作为炎症介质，介导了免疫炎症反应。心脏直视手术、CPB可诱发PCT水平显著、短暂升高，并且与创伤时间有相关性。

Objective To investigate the clinical significance of procalcitonin （PCT） as a non- infectious factor after cardiac surgery.Methods Eighty adult patients who underwent selective cardiac operation under direct vision were divided into cardiopulmonary bypass （CPB） group and non-CPB group according to whether CPB was taken or not; the levels of PCT, C-reactive protein （CRP） and white blood cell count （WBC） were measured before and at 0, 12, 36, 60 h after operation, and the time of thoracotomy was recorded. All the data were analyzed.Results The levels of PCT and CRP in the two groups at 0, 12, 36 and 60 h after operation were significantly higher than those before operation （P〈0.05）. The times of peak of PCT and CRP levels in CPB group were earlier than those in non-CPB group. The level of PCT was significantly higher in CPB group than that in non-CBP group at 0 and 12 h after operation （P〈0.05）. Compared with that before surgery, the values of WBC significantly increased at 12, 36 and 60 h after cardiac surgery （P〈0.05）. The level of WBC in CPB group was higher than that in non-CPB group at 36 and 60 h after operation （P〈0.05）. There was a correlation between the time of thoracotomy in cardiac surgery and the levels of PCT at the end of the operation and 12, 36 h after surgery. The correlation coefficients between the different groups were 0.414, 0.489, 0.432 respectiely, and the difference was statistically significant （P〈0.05）.Conclusions PCT is not only a sensitive, specific indicator of systemic infection, but also an inflammatory mediator mediating immune inflammatory response. Cardiac surgery with direct vision and CPB can induce a brief and significant increase in PCT levels, and are associated with trauma time.