ERCP取石术后胆道感染患者外周血降钙素原和白介素-6变化及其临床意义

Clinical implication of serum procalcitonin and interleukin-6 levels in patients with biliary tract stone after stone removal

目的探讨采用内窥镜下逆行性胰胆管造影(ERCP)取石术后胆道感染患者血清降钙素原(PCT)、白细胞介素-6(IL-6)和外周血白细胞计数(WBC)的变化及其临床意义。方法2010年7月~2020年7月我院收治的142例胆总管结石患者,行ERCP下十二指肠乳头括约肌切开取石术。另选择健康人120例作血清和血液检测对照。采用ELISA法检测血清IL-6水平,采用双抗体夹心免疫发光法测定血清PCT水平。应用受试者工作特征曲线(ROC)分析PCT、IL-6和WBC预测术后并发胆道感染的价值。结果在ERCP取石术前,胆总管结石患者外周血PCT、IL-6、WBC、ALT、TBIL和GGT水平分别为(5.1±1.8)μg/L、(63.8±18.3)pg/mL、(13.7±2.8)×10^(9)/L、(86.8±8.8)U/L、(49.4±16.6)μmol/L和(89.5±22.7)U/L,在ERCP取石术后3 d患者外周血各指标分别为(2.5±1.9)μg/L、(31.9±12.2)pg/mL、(6.5±3.1)×10^(9)/L、(79.2±5.3)U/L、(13.0±3.3)μmol/L和(56.8±14.8)U/L,均显著高于健康人【分别为(0.3±0.1)μg/L、(25.0±8.2)pg/mL、(5.2±0.8)×10^(9)/L、(18.7±6.8)U/L、(8.3±2.7)μmol/L和(24.2±6.1)U/L,P<0.05】;本组发生术后胆道感染18例(12.7%),发现革兰阴性菌15例(83.3%),革兰阳性菌3例(16.7%);并发胆道感染患者外周血PCT、IL-6和WBC分别为(4.9±1.1)μg/L、(52.3±10.6)pg/mL和(11.4±1.3)×10^(9)/L,显著高于未感染患者【分别为(0.1±0.0)μg/L、(28.9±8.2)pg/mL和(5.8±2.1)×10^(9)/L,P<0.05】;ROC曲线分析表现,应用PCT预测ERCP取石术后并发胆道感染的敏感度为91.8%,特异性为74.3%,IL-6预测的敏感度为95.4%,特异性为80.5%,WBC预测的敏感度为94.1%,特异性为78.1%,而三者联合预测术后并发胆道感染的AUC为0.958,其敏感度为93.2%,特异性为91.1%,预测价值显著优于任一单项检测(P<0.05)。结论在ERCP取石术后,检测血清PCT和/或IL-6水平可以帮助预测术后胆道感染的发生,而给予及时的处理。

Objective The aim of this study was to investigate the changes and clinical implication of serum procalcitonin(PCT)and interleukin-6(IL-6)levels in patients with biliary tract stone after stone removal under endoscopic retrograde cholangiopancreatography(ERCP).Methods 142 patients with common bile duct stones and 120 healthy persons were enrolled in this study between July 2010 and July 2020,and all patients underwent stone removal under ERCP.Serum PCT and IL-6 were detected by enzyme-linked immunosorbent assay and double-antibody sandwich immunoluminescence assay.The forecasting value of serum parameters was evaluated by area under receiver operating characteristic curve(AUC).Results Before operation under ERCP,serum PCT,IL-6 levels,peripheral blood white blood cell(WBC)counts,serum ALT,bilirubin and GGT levels in 142 patients with biliary tract stone were(5.1±1.8)μg/L,(63.8±18.3)pg/mL,(13.7±2.8)×10^(9)/L,(86.8±8.8)U/L,(49.4±16.6)μmol/L and(89.5±22.7)U/L,they decreased to(2.5±1.9)μg/L,(31.9±12.2)pg/mL,(6.5±3.1)×10^(9)/L,(79.2±5.3)U/L,(13.0±3.3)μmol/L and(56.8±14.8)U/L three days after operation,but all significantly higher than[(0.3±0.1)μg/L,(25.0±8.2)pg/mL,(5.2±0.8)×10^(9)/L,(18.7±6.8)U/L,(8.3±2.7)μmol/L and(24.2±6.1)U/L,respectively,P<0.05]in control;the post-operational biliary infections occurred in 18 cases(12.7%)out of our series,and the Gram-negative and Gram-positive bacteria accounted for 83.3%and 16.7%,respectively;serum PCT,IL-6 and peripheral blood WBC counts in patients with biliary infection were(4.9±1.1)μg/L,(52.3±10.6)pg/mL and(11.4±1.3)×10^(9)/L,all significantly higher than[(0.1±0.0)μg/L,(28.9±8.2)p g/mL and(5.8±2.1)×10^(9)/L,respectively,P<0.05]in those without infection;the ROC analysis showed that the sensitivity(Se)and specificity(Sp)were 91.8%and 74.3%by serum PCT,95.4%and 80.5%by serum IL-6,and 94.1%and 78.1%by WBC counts,but they increased to 93.2%and 91.1%by the three combination,significantly higher than anyone alone(P<0.05)in predicting biliary infection after the stone removal under ERCP.Conclusion The surveillance of serum PCT and IL-6 levels might help predict the biliary infection in patients with cholelithiasis after stone removal under ERCP,and guide clinical management early and appropriately.