肝门部胆管癌ERCP术后胆道感染患者的血清PCT、CRP水平、病原菌分布及危险因素分析

Analysis of procalcitonin,C-reactive protein levels,pathogens distribution,and risk factors in patients with biliary tract infection after endoscopic retrograde cholangiopancreatography for hilar cholangiocarcinoma

目的研究肝门部胆管癌经内镜逆行胰胆管造影(ERCP)术后胆道感染患者的血清降钙素原(PCT)、C-反应蛋白(CRP)水平、病原菌分布及危险因素。方法选择2018年3月至2019年5月在上海市宝山区罗店医院接受治疗的肝门部胆管癌的患者50例作为研究对象,按照感染情况分为感染组18例和非感染组32例。比较两组患者的血清PCT、CRP水平及感染组的病原菌状况。结果感染组患者的病原菌感染以G-菌为主,约占83.33%,主要为大肠埃希菌(33.33%)、阴沟肠杆菌(22.22%)、肠炎克雷伯菌(22.22%)、铜绿假单胞菌(5.56%);感染组患者的血清PCT、CRP水平分别为(10.41±3.32)ng/mL、(23.42±2.23)mg/L,明显高于非感染组患者的(5.12±0.31)ng/mL、(8.55±2.15)mg/L,差异均有统计学意义(P<0.05);单因素分析结果显示,患者的年龄、性别、是否置入胆道支架与术后胆道感染无关(P>0.05),而恶性病变、肝门部梗阻、手术操作时间≥30 min与术后胆道感染有关(P<0.05);将单因素分析中P<0.05的指标纳入多因素分析,多因素Logistic回归分析显示,恶性病变、肝门部梗阻、手术操作时间≥30 min是术后发生胆道感染的独立危险因素(P<0.05)。结论肝门部胆管癌ERCP术后胆道感染患者的血清PCT、CRP水平均明显升高,病原菌感染多以G-菌为主;恶性病变、肝门部梗阻、手术操作时间≥30 min是术后发生胆道感染的独立危险因素。

Objective To study the levels of serum procalcitonin(PCT),C-reactive protein(CRP),pathogen distribution,and risk factors in patients with biliary tract infection after endoscopic retrograde cholangiopancreatography(ERCP)for hilar cholangiocarcinoma.Methods Fifty patients with hilar cholangiocarcinoma treated in Luodian Hospital of Baoshan District of Shanghai from March 2018 to May 2019 were selected as the research objects.According to the infection,they were divided into the infection group(18 cases)and the non-infection group(32 cases).The levels of serum PCT and CRP were compared between the two groups and the status of pathogens in the infection group was investigated.Results The main pathogens in the infection group were G-bacteria,accounting for 83.33%,mainly Escherichia coli(33.33%),Enterobacter cloacae(22.22%),Klebsiella enteritidis(22.22%),and Pseudomonas aeruginosa(5.56%).The levels of serum PCT and CRP in the infection group were(10.41±3.32)ng/mL and(23.42±2.23)mg/L,respectively,which were significantly higher than(5.12±0.31)ng/mL and(8.55±2.15)mg/L in non-infection group(P<0.05).The results of univariate analysis showed that age,gender,and whether biliary stents were inserted were not related to postoperative biliary tract infection(P>0.05),while malignant lesions,hilar obstruction,and operation time≥30 min were related to postoperative biliary tract infection(P<0.05).Multivariate logistic regression analysis showed that hilar obstruction and operation time≥30 min were independent risk factors for postoperative biliary tract infection(P<0.05).Conclusion The levels of PCT and CRP in patients with biliary tract infection after ERCP for hilar cholangiocarcinoma were significantly increased,and the pathogen infection was mainly G-bacteria.Malignant lesions,hilar obstruction,and operation time≥30 min were independent risk factors for postoperative biliary tract infection.