前蛋白转化酶枯草溶菌素9作为评价食管病变内镜下黏膜下剥离术后患者感染状况的新标志物

Serum proprotein convertase subtilisin/kexin type 9 as a new marker in evaluating the infectious status of patients after endoscopic submucosal dissection for esophageal neoplasm

目的探讨前蛋白转化酶枯草溶菌素9(proprotein convertase subtilisin/kexin type 9,PCSK9)作为食管病变内镜下黏膜下剥离术(endoscopic submucosal dissection,ESD)术后早期感染预测指标的价值。方法纳入2017年3月至2017年10月复旦大学附属中山医院收治的65例浅表肿物行食管ESD患者。术后监测患者体温,定义体温≥37.5℃为ESD后发热,对体温≥38℃的患者进行血培养。同时检测患者血液中的PCSK9、脂多糖(lipopolysaccharide,LPS)和其他标志物如白细胞计数(white blood cell,WBC)、C-反应蛋白(C-reaction protein,CRP)和白介素6(interleukin 6,IL-6)等。结果37例患者出现发热,其中12例患者接受血培养,其中1例显示阳性结果。血PCSK9、LPS、WBC、CRP和IL-6均在发热组增加;与37.5℃≤体温<38℃的患者相比,在体温≥38℃的患者中,只有PCSK9和IL-6显著增加。体温≥38℃的患者PCSK9平均水平为(355.29±56.17)ng/mL,而37.5℃≤体温<38℃患者的平均PCSK9水平为(304.19±60.91)ng/mL(P=0.020)。在体温≥38℃的患者中,血PCSK9和LPS水平正相关(r=0.720,P=0.011)。结论PCSK9可作为食管ESD患者术后感染的早期敏感生物标志物。

Objective To explore the value of proprotein convertase subtilisin/kexin type 9(PCSK9)as a predictor of early infectious status after endoscopic submucosal dissection(ESD)for esophageal neoplasm.Methods A total of 65 patients who had undergone esophageal ESD for superficial neoplasm in Zhongshan Hospital,Fudan University from March to October 2017 were enrolled.Their body temperature(BT)was monitored and post-ESD fever was defined as BT≥37.5℃.Blood culture was taken in the patients who had BT≥38℃.An investigation was made of PCSK9,lipopolysaccharide(LPS)and other markers such as white blood cell(WBC),C-reaction protein(CRP)and interlukin-6(IL-6).Results It was found that 37/65 patients developed a fever,and 12/37 received blood culture,with one showing a positive result.Serum PCSK9,LPS,WBC,CRP and IL-6 all increased in the fever cohort;however,only PCSK9 and IL-6 increased significantly in those who had BT≥38℃when compared with those who had 37.5℃≤BT<38℃.The mean levels of PCSK9 were(355.29±56.17)ng/mL in the patients of BT≥38℃,versus(304.19±60.91)ng/mL in the patients of 37.5℃≤BT<38℃(P=0.020).A positive correlation plus a linear regression relationship was observed between the levels of serum PCSK9 and LPS in those who had BT≥38℃(r=0.720;P=0.011).Conclusions PCSK9 could serve as an early and sensitive biomarker in detecting the infectious status of a patient during the perioperative period of esophageal ESD.