肛周坏死性筋膜炎患者4种血液生化指标对疾病预后的预测

Prediction of disease prognosis by four blood biochemical indicators in patients with perianal necrotizing fasciitis

目的坏死性筋膜炎(NF)病情恶化程度高、进展快,即使接受相关治疗病死率仍较高。文中探讨患者血清降钙素原(PCT)、C-反应蛋白(CRP)与血浆清蛋白(ALB)、前白蛋白(PA)对NF预后的评估价值。方法回顾性分析合肥市第一人民医院集团2009年5月至2019年8月收治的41例肛周NF病例临床资料及入院时血清PCT、CRP和血浆ALB、PA检测数据,统计并分析患者病死情况。将本组患者按照不同预后分为生存组与死亡组,评价各项指标对NF预后的预测价值。结果患者男女比例9.25∶1,存在多种合并症,糖尿病最常见(41.46%)。本组患者混合感染率12.20%、细菌培养阴性率17.07%。细菌种类较多,肺炎克雷伯氏菌(20.45%)、大肠埃希菌(15.91%)、链球菌(15.91%)较为多见。本组患者均接受手术治疗,病死率17.07%。生存组与死亡组患者性别、合并症、微生物测定结果、6 h内手术情况、营养支持等差异无统计学意义(P>0.05);而发病至入院时间、入住ICU者占比、血清PCT与CRP、血浆ALB与PA、行负压封闭引流技术(VSD)引流术者占比差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,患者发病至入院时间长、入住ICU、高血清PCT和CRP、低血浆ALB和PA、未行VSD引流术是预后不良的危险因素(P<0.05)。血清PCT、CRP及血浆ALB、PA预测预后不良的受试者工作特征(ROC)曲线下面积分别为0.859、0.811、0.802、0.747;4项指标联合预测的曲线下面积为0.926。结论肛周NF患者在性别、合并症、微生物等方面有一定特征,且死亡风险高。血清PCT、CRP及血浆ALB、PA与预后有关,可作为评估预后的生化指标。

Objective Necrotizing fasciitis(NF) has a high rate of deterioration and rapid progress, and the mortality rate is still high even after receiving treatment. The study was to explore evaluation value of serum procalcitonin(PCT), C-reactive protein(CRP) and plasma albumin(ALB) and prealbumin(PA) in the prognosis of patients with perianal necrotizing fasciitis(NF). Methods All data and detection data of serum PCT, CRP and plasma ALB, PA at admission from 41 perianal NF patients admitted to Hefei first people’s Hospital Group from May 2009 to August 2019 were retrospectively collected. The death status was statistically analyzed. The patients in this group were divided into survival group and non-survival group, and the predictive value of various indicators on the prognosis of NF was evaluated. Results The ratio of male to female was 9.25∶1. There were multiple complications, and diabetes mellitus was most common(41.46%). The patients with mixed infection and negative bacterial culture accounted for 12.20% and 17.07%, respectively. There were many kinds of bacteria detected out. Klebsiella pneumoniae(20.45%), Escherichia coli(15.91%) and streptococcus(15.91%) were common. All underwent one or more surgical treatments, with mortality of 17.07%. There was no significant difference between survival group and death group in gender, complications, microbiological test results, operation status within 6 h or and nutrition support(P>0.05), while there were significant differences in time from onset to admission, proportion of patients in ICU, serum PCT and CRP, plasma ALB and PA and proportion of patients undergoing vacuum sealing drainage(VSD)(P<0.05). Logistic multivariate regression analysis showed that long duration from onset to admission, staying in ICU, high serum PCT and CRP, low plasma ALB and PA, and no conducting VSD were risk factors of poor prognosis(P<0.05). Serum PCT, CRP and plasma ALB, PA predict the prognosis receiver operating characteristic(ROC) curve, the area under the curve is 0.859, 0.811, 0.802, 0.747;the area under the curve of the four indicators combined prediction is 0.926. Conclusion There are certain features in terms of gender, complications and microorganisms in perianal NF patients. Death risk is high. In addition, serum PCT and CRP, plasma ALB and PA are also related with prognosis, which can be applied as biochemical indexes for prognosis evaluation.