胰十二指肠切除术后腹腔感染血清CRP/ALB、IMA、Ghrelin水平及诊断价值

Diagnostic value of changes in serum CRP/ALB,IMA,and Ghrelin levels in abdominal infection after pancreaticoduodenectomy

目的探究血清C-反应蛋白(CRP)/白蛋白(ALB)、缺血修饰白蛋白(IMA)、生长激素释放肽(Ghrelin)在胰十二指肠切除(PD)术后腹腔感染中的水平变化及临床价值。方法选取承德医学院附属医院收治的PD患者130例,根据术后是否发生腹腔感染分为感染组(52例)与无感染组(78例)。分析血清CRP/ALB、IMA、Ghrelin水平手术前后变化情况及临床价值。结果两组术前黄疸病程、术后胰瘘、腹腔积液比较,差异有统计学意义(P<0.05);感染组术后1、3、5 d血清CRP/ALB、IMA、Ghrelin水平、APACHEⅡ评分高于无感染组(P<0.05);感染组术后1、3、5 d血清CRP/ALB(r=0.593、0.500、0.587)、IMA(r=0.684、0.501、0.638)、Ghrelin(r=0.504、0.595、0.585)与APACHEⅡ评分呈正相关(P<0.05);Logistic回归分析,术后3 d血清CRP/ALB、IMA、Ghrelin与PD术后腹腔感染相关(P<0.05);联合诊断的曲线下面积(AUC)为0.924,诊断敏感度为82.69%,特异度为88.46%,优于三者单独诊断(P<0.05)。结论血清CRP/ALB、IMA、Ghrelin在PD术后腹腔感染中呈升高状态,与感染发生密切相关,联合检测具有良好诊断价值,还能为临床评估病情程度提供相关依据。

OBJECTIVE To explore the changes and clinical value of serum C-reactive protein(CRP)/albumin(ALB),ischemia modified albumin(IMA)and Ghrelin levels in abdominal infection after pancreaticoduodenectomy(PD).METHODS A total of 130 PD patients admitted to our hospital were recruited and divided into the infection group(52 cases)and non-infection group(78 cases)according to whether abdominal infection occurred after surgery.The changes of serum CRP/ALB,IMA,and Ghrelin levels before and after surgery were detected and their clinical value were evaluated.RESULTS There were significant differences in the course of jaundice before operation,postoperative pancreatic fistula and abdominal effusion between the two groups(P<0.05).Serum CRP/ALB,IMA,Ghrelin levels and APACHEⅡscores in the infection group were significantly higher than those in the non-infection group on 1,3,and 5 days after surgery(P<0.05).Serum CRP/ALB(r=0.593,0.500,0.587),IMA(r=0.684,0.501,0.638),Ghrelin(r=0.504,0.595,0.585)and APACHEⅡscores were positively correlated with APACHEⅡscores in the infection group on the 1 st,3 rd,and 5 th days after operation(P<0.05).Logistic regression analysis showed that serum CRP/ALB,IMA,and Ghrelin were significantly correlated with postoperative abdominal infections on the 1 st,3 rd,and 5 th day after PD(P<0.05).The AUC of the combined diagnosis was 0.924,the diagnostic sensitivity was 82.69%,and the specificity was 88.46%,which was significantly better than the three separate diagnoses(P<0.05).CONCLUSION Serum CRP/ALB,IMA and Ghrelin significantly elevate in abdominal infection after PD,and are closely related to the occurrence of infection.Combined detection has good diagnostic value and can provide relevant evidence for clinical evaluation of the disease.