C反应蛋白/白蛋白比值对胰十二指肠切除术后并发症预测价值的探讨

Predictive value of C-reactive protein/albumin ratio for complications after pancreaticoduodenectomy

目的探讨C反应蛋白/白蛋白比值(C-reactive protein/albumin ratio,CAR)对胰十二指肠切除术(pancreaticoduodenectomy,PD)后并发症的预测价值。方法回顾性收集2015–2018年期间于新疆医科大学第一附属医院胰腺外科行PD的134例患者的临床资料,探索CAR对于PD术后胰瘘(postoperative pancreatic fistula,POPF和腹腔感染的预测价值。结果 134例患者中,术后发生并发症84例,其中POPF 38例,腹腔感染32例,胆汁漏5例,胃排空延迟(delayed gastric emptying,DGE)63例,术后出血(post pancreatectomy hemorrhage,PPH)13例,切口感染8例,乳糜漏1例。并发症组和无并发症组患者的性别、年龄、BMI、美国麻醉医师协会(ASA)分级、肿瘤性质、肿瘤直径、手术时间、术中出血量、糖尿病史、饮酒史、吸烟史和黄疸史比较差异均无统计学意义(P>0.05),但并发症组的住院时间长于无并发症组(P<0.05)。POPF者和腹腔感染者术后1、3及5 d的CAR值均相应高于非POPF者(除外术后1 d)和非腹腔感染者(P<0.05)。术后第3天的CAR预测POPF的灵敏度为79.95%,特异度为86.46%;预测腹腔感染的灵敏度为75.00%,特异度为81.37%,结果优于单纯使用降钙素原(PCT),但与C反应蛋白(CRP)+PCT和CRP接近。结论术后CAR可以较好地预测PD后POPF和腹腔感染的发生,且效果优于单纯使用PCT。

Objective To evaluate the predictive value of C-reactive protein/albumin ratio(CAR) for postoperative complications of pancreaticoduodenectomy(PD). Methods The clinical data of 134 patients with pancreaticoduodenectomy(PD) in the Department of Pancreatic Surgery of The First Affiliated Hospital of Xinjiang Medical University from 2015 to 2018 were retrospectively collected, including general conditions and postoperative complications. The predictive value of CAR was calculated. Results Of the 134 patients, 38 patients suffered from postoperative pancreatic fistula(POPF), 32 patients suffered from abdominal infection, 5 patients suffered from biliary fistula, 63 patients suffered from delayed gastric emptying(DGE), 13 patients suffered from post pancreatectomy hemorrhage(PPH), 8 patients suffered from wound infection, and 1 patient suffered from chyle leakage. There was no significant difference in general conditions such as gender, age, BMI, American Society of Anesthesiologists(ASA) score,tumor nature, tumor diameter, operative time, intraoperative blood loss, diabetes history, jaundice history, and drinking history(P>0.05), but the hospital stay in the complication group was longer than that of the non-complication group(P<0.05). The value of CAR in the pancreatic fistula and abdominal infection group were significantly higher than those in the non-complication group at 1 d, 3 d and 5 d(exclude 1 day after surgery on POPF), the difference was statistically significant(P<0.05). On the 3 rd day after surgery, the sensitivity of CAR predicting POPF was 79.95%, the specificity was 86.46%;the sensitivity of predicting abdominal infection was 75.00%, the specificity was 81.37%, and the result was better than using procalcitonin(PCT) alone, but similar with C-reactive protein(CRP) alone or CRP+PCT.Conclusion Postoperative CAR can better predict POPF and abdominal infection after PD, and the effect is better than PCT alone.