急性胆管炎患者血清降钙素原变化特点及临床意义

Characteristics and clinical significance of serum procalcitonin changes in patients with acute cholangitis

目的 探讨急性胆管炎患者血清降钙素原(PCT)变化特点及临床意义。方法 选取2020年6月—2022年6月本院急性胆管炎患者94例作为研究组,另选同期无感染的慢性胆囊炎患者36例作为对照组。比较2组血清PCT、血小板数量(PLT)水平,以及不同病情程度急性胆管炎患者血清PCT、PLT水平及变化率,采用Pearson相关性分析血清PCT、PLT与急性生理学与慢性健康状况(APACHEⅡ)评分之间相关性,采用受试者工作特征曲线(ROC)分析血清PCT、PLT对急性胆管炎的诊断价值。结果 研究组血清PCT水平较对照组高,PLT水平较对照组低(P<0.05);入院后24 h、48 h、72 h,Ⅰ级急性胆管炎患者血清PCT水平及PCT_(72 h)变化率均低于Ⅱ级、Ⅲ级,Ⅱ级低于Ⅲ级,Ⅰ级、Ⅱ级急性胆管炎患者PLT水平及PLT_(72 h)变化率均高于Ⅲ级(P<0.05);PLT与APACHEⅡ评分成负相关(r=-0.571,P<0.001),PCT与APACHEⅡ评分成正相关(r=0.636,P<0.001);PCT的曲线下面积为0.959,最佳诊断临界值为1.04μg/L,敏感度为89.36%,特异度为97.22%;PLT的曲线下面积为0.830,最佳诊断临界值为205.05×10^(9)/L,敏感度为84.04%,特异度为75.00%。结论 血清PCT随着急性胆管炎患者病情严重程度增加而升高,血清PCT、PLT与APACHEⅡ评分具有相关性,临床需重点关注急性胆管炎患者血清PCT、PLT指标变化趋势,对临床早期疾病鉴别急性胆管炎以及患者病情严重程度具有指导意义。

Objective This paper aims to investigate the changes and clinical significance of serum procalcitonin(PCT)in patients with acute cholangitis.Methods A total of 94 patients with acute cholangitis in our hospital from June 2020 to June 2022 were selected as the study group,and 36 patients with chronic cholecystitis without infection in the same period were selected as the control group.The levels of serum PCT and platelet count(PLT)were compared in the two groups,as well as the levels and changing rates of serum PCT and PLT in patients with acute cholangitis of different severity.Pearson correlation analysis was used to analyze the correlation between serum PCT and PLT and the scores of acute physiology and chronic health(APACHEⅡ),and the diagnostic value of serum PCT and PLT in acute cholangitis was analyzed by using the subject work characteristic curve(ROC).Results The serum PCT level in the study group was higher than that in the control group,and the PLT level was lower than that in the control group(P<0.05).At 24 h,48 h and 72 h after admission,the serum PCT level and the change rate of PCT72h in patients with gradeⅠacute cholangitis were lower than those in patients with gradeⅡand gradeⅢacute cholangitis,gradeⅡacute cholangitis were lower than those in patients with gradeⅢacute cholangitis,and the changing rates of PLT level and PLT72h in patients with gradeⅠandⅡacute cholangitis were higher than those in patients with gradeⅢacute cholangitis(P<0.05).PLT was negatively correlated with APACHEⅡscore(r=-0.571,P<0.001),while PCT was positively correlated with APACHEⅡscore(r=0.636,P<0.001).The area under the curve of PCT was 0.959,and the optimal diagnostic threshold was 1.04μg/L,sensitivity was 89.36%,specificity was 97.22%.The area under the curve of PLT was 0.830,and the best diagnostic threshold was 205.05×10^(9)/L,sensitivity was 84.04%,and specificity was 75.00%.Conclusion Serum PCT increases with the severity of acute cholangitis.Serum PCT and PLT are correlated with APACHEⅡscore.Clinical attention should be focused on the changing trend of serum PCT and PLT in patients with acute cholangitis,which is of guiding significance for the clinical differentiation of early acute cholangitis and patients’severity.