PCT及其清除率在重症急性胰腺炎继发感染的诊治及预后价值研究

Diagnosis and Treatment of Pct and Its Clearance Rate in Secondary Infection of Severe Acute Pancreatitis

目的探讨降钙素原(PCT)及其清除率(PCTc)在急性重症胰腺炎继发感染的临床价值。方法通过方便选取2015年10月—2017年9月在该院住院的诊断为急性重症胰腺炎(SAP)85例患者,同时方便选取同期在该院住院的106例急性非重症性胰腺炎为对照组。急性重症胰腺炎根据其预后情况可分为存活组68例,死亡组17例。分别回顾性分析观察组和对照组患者的降钙素原(PCT)、C反应蛋白(CRP)和白细胞(WBC)含量,观察比较生存组和死亡组的不同时间点PCTc清除率的改变,并绘制PCT、CRP、WBC在早期诊断急性重症胰腺炎继发性感染中ROC曲线。结果入院时,观察组CRP (142.5±88.2)mg/L明显高于对照组(98.8±45.5)mg/L(t=15.5,P=0.03),但观察组PCT(1.58±1.06)ng/mL与对照组(1.36±0.88)ng/mL, WBC(13.5±8.5)×10~9/L与对照组(13.1±8.0)×10~9/L,比较均差异无统计学意义(P>0.05)。分别对存活组和死亡组PCTc比较,存活组入院第7、14、21天PCTc分别为(24.8±26.18)%、(52.8±22.26)%、(70.2±28.26)%,均明显高于死亡组(10.2±22.31)%、(18.6±24.37)%、(37.2±25.35)%,两两比较均差异有统计学意义(t=6.65,15.4, 20.1,P=0.03,0.01,0.01)。ROC曲线显示PCT与SAP继发感染AUC值为0.983,早期诊断的相关性最好。结论血清PCT是重症急性胰腺炎继发感染早期诊断的理想生物学指标。动态观察不同时间点的PCTc是一个更为可靠及敏感的指标在SAP患者的治疗监测及病情预后与转归。

Objective To investigate the clinical value of procalcitonin （PCT） and its clearance rate （PCTc） in the secondary infection of acute severe pancreatitis. Methods 85 patients with acute severe pancreatitis （SAP） were enrolled in the hospi- tal from October 2015 to September 2017. 106 patients with acute non-severe pancreatitis who were hospitalized in the hospital were random selected as the control group. Acute severe pancreatitis can be divided into survival group in 68 cases and death group in 17 cases according to its prognosis. The levels of procalcitonin （PCT）, C-reactive protein （CRP） and white blood cells （WBC） were observed retrospectively in the observation group and the control group, and the changes of PCTc clearance rate at different time points in the survival group and the death group were observed. The ROC curves of PCT, CRP and WBC in the early diagnosis of secondary infection of acute severe pancreatitis were drawn. Results At admission, the CRP （142.5±88.2）mg/L in the observation group was significantly higher than that in the control group （98.8± 45.5）mg/L （t=15.5, P=0.03）, but the observation group was PCT （1.58±1.06）ng/mL, there was no significant difference be- tween ml and control group （1.36±0.88） ng/mL, WBC （13.5±8.5）×10^9/L and control group （13.1±8.0）×10^9/L （P〉0.05）. Comparing the PCTC of the survival group and the death group, the PCTc of the survival group on the 7th, 14th, and 21st day were （24.8±26.18）%, （52.8±22.26）%, and （70.2±28.26）%, respectively, which were significantly higher than the death group （10.2±22.31）%, （18.6±24.37）%, （37.2±25.35）%, there were significant differences between the two groups （t=6.65, 15.4,20.1,P=0.03,0.01,0.01）. The ROC curve showed that the AUC value of PCT and SAP secondary infection was 0.983, and the correlation was the best in early diagnosis. Conclusion Serum PCT is an ideal biological indicator for the early diagnosis of secondary infection of severe acute panereatitis. Dynamic observation of PCTe at different time points is a more reliable and sensitive indicator of treatment monitoring and outcome in SAP patients.