C反应蛋白在胃癌术后吻合口漏的预测价值

C-reactive Protein as an Early Predictor for Anastomotic Leakage in D2 Gastrectomy

目的:观察胃癌D2根治术后吻合口漏患者,术后不同时间点血清C反应蛋白(CRP)的表达水平,探讨其在预测胃癌根治术后吻合口漏中的临床意义。方法:收集2015年10月—2016年12月在青海大学附属医院胃肠外科行胃癌D2根治术患者为观察对象,依据在根治术后是否发生吻合口漏为标准,分为正常对照组与吻合口漏组,比较术前1天与术后第1天、3天、5天、7天血清中CRP的表达水平,并绘制受试者工作特征曲线(ROC曲线),分析其在对D2根治术后吻合口漏的预测价值。结果:与正常对照组相比,吻合口漏组术后第3天、5天、7天血清中CRP的量显著增加(P<0.05),而术后第3天时,曲线下面积(AUC)值达到最大0.965(95%CI 0.924~0.987;P<0.001),临界值为141mg/L时,其敏感度与特异度分别为100.0%及87.3%。结论:行胃癌D2根治术的患者,术后动态观察血清中CRP的水平对于早期及时发现吻合口漏有积极的临床意义。若术后第3天CRP值>141mg/L时,在排除感染等可能性后,要高度怀疑发生吻合口漏。

Objective:This syudy is aimed to observe the expression of serum C-reactive protein(CRP) in patients with anastomotic leakage after D2 gastrectomy,and to explore its clinical significance in predicting anastomotic leakage.Methods:This study was conducted from October 2015 to December 2016 in the Department of Gastrointestinal Surgery,Affiliated Hospital of Qinghai University.The serum CRP level was measured before operation and at postoperative days 1、3、5、7,and the serum CRP level of the groups with and without anastomotic leakage was compared to analyze its prediction for anastomotic leakage.Receiver operating characteristic(ROC) curve was used to estimate the value of monitoring CRP to predict anastomotic leakage after D2 gastrectomy.Results:Compared with the control group,the amount of CRP in the serum of patients with anastomotic leakage was significantly increased on the 3 rd,5 th,and 7 th postoperative day(P<0.05),and the AUC of POD 3 was the largest,which reached 0.965(95% CI 0.924~0.987;P<0.001).When this value was used as the point of tangency to predict for anastomotic leakage,the sensitivity and specificity were 100.0% and 87.3%.Conclusion:Dynamic observation of serum CRP levels after D2 gastrectomy has showed positive clinical significance for the early detection of anastomotic leakage.If the CRP value is greater than 141 mg/L on POD 3 after D2 gastrectomy,it is highly suspected that an leakage may occur after excluding the possibility of infection.