血清PIC和CRP/ACB比值用于预测上尿路结石围手术期感染的应用价值

The Value of Serum PCT and CRP/ALB Ratio in the Prediction of Perioperative Infection of Upper Urinary Tract Calculi

目的:检测上尿路结石患者术前和术后血清降钙素原(PCT)和C反应蛋白(CRP)/血清白蛋白(ALB)比值,并分析其与围手术期感染的关系。方法:选取2017年4月至2019年5月钟祥市人民医院泌尿外科因上尿路结石经手术的患者180例为研究对象,按照入院时是否发生感染分为感染组(n=100)与无感染组(n=80),对感染组进一步分为显著感染组(n=60)与隐匿感染组(n=40),术后是否发生感染分为术后感染组(n=42)与无感染组(n=138),利用全自动生化分析仪检测血清PCT和CRP、Alb水平,并计算CRP/Alb比值,根据患者相关指标及临床特征计算入院时患者急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分;检测患者入院白细胞计数(WBC)、红细胞计数(RBC);记录患者体温(T),心率(HR),呼吸频率(RR)。结果:入院感染组患者外周血WBC、RBC数目、APACHE评分显著高于入院无感染组(P<0.05);入院1d,无感染组患者血清PCT、CRP水平、CRP/Alb比值较显著感染与隐匿感染组患者降低(P<0.05),Alb水平升高(P<0.05);隐匿感染组患者血清PCT、CRP水平、CRP/Alb比值较显著感染组患者显著降低(P<0.05);术后1d,术后感染组患者血清PCT、CRP水平、CRP/Alb比值较无感染组显著升高(P<0.05),ALB水平降低(P<0.05);入院1d,患者血清CRP水平、CRP/Alb比值单独检测对预测术前感染具有一定价值,但是灵敏度不高,二者联合检测预测术前感染的AUC为0.909,对应敏感度为90.50%,特异性为81.70%;术后1d,患者血清PCT水平、CRP/Alb比值单独检测对预测术前感染具有一定价值,二者联合检测预测术前感染的AUC为0.977,对应敏感度为92.90%,特异性为98.60%。结论:血清PCT和CRP/Alb比值在术前与术后感染组患者中升高,二者可能作为上尿路结石围手术期感染的生物标记。

Objective: To detect the serum procalcitonin(PCT)and C-reactive protein(CRP)/serum albumin(ALB)ratio in patients with upper urinary tract calculi before and after operation,and to analyze their relationships with perioperative infection.Methods:180 patients with upper urinary tract calculi who underwent surgery in the Department of Urology of Zhongxiang People's Hospital from April 2017 to May 2019 were selected as the study subjects.According to whether infection occurred at admission,the patients were divided into infection group(n=100)and non-infection group(n=80).The infection group was further divided into significant infection group(n=60)and hidden infection group(n=40).Postoperative infection was divided into infection group(n=42)and non-infection group(n=138).Serum PCT,CRP and Alb levels were measured by automatic biochemical analyzer,and CRP/Alb ratio was calculated.Acute physiology and chronic health score system II(APACHE II)was calculated according to the related indicators and clinical characteristics of patients,White blood cell count(WBC)and red blood cell count(RBC)were measured,and the temperature(T),heart rate(HR)and respiratory rate(RR)were recorded.Results:The numbers of WBC,RBC and APACHE score in the patients with hospital infection were significantly higher than those in the patients without hospital infection(P<0.05).One day after admission,the levels of serum PCT,CRP,CRP/Alb in the non-infected group were lower than those in the infected and occult infection group(P<0.05),while the level of Alb was higher(P<0.05);the levels of serum PCT,CRP and CRP/Alb in the occult infection group were lower than those in the infected group(P<0.05).One day after operation,the levels of PCT,CRP and CRP/Alb in the infected group were significantly higher than those in the non-infected group(P<0.05),while the level of ALB was lower(P<0.05).One day after admission,the serum CRP level and CRP/Alb ratio of patients were detected separately,but the sensitivity was not high.The AUC of combined detection for predicting preoperative infection was 0.909,the corresponding sensitivity was 90.50%,and the specificity was 81.70%;One day after operation,the serum PCT level and CRP/Alb ratio were detected separately,which had a certain value in predicting preoperative infection.The combined detection of them predicted preoperative infection with AUC of 0.977,corresponding sensitivity of 92.90%and specificity of 98.60%.Conclusions:The serum PCT and CRP/Alb ratio are increased in patients with infection before and after operation,which may be used as biomarkers for perioperative infection of upper urinary tract stones.