血清PCT、sICAM-1联合HMGB1预测急性阑尾炎患儿手术切口感染风险的临床研究

Clinical Study of Serum PCT,sICAM-1 Combined with HMGB1 in Predicting the Risk of Surgical Incision Infection in Children with Acute Appendicitis

目的:探讨血清降钙素原(PCT)、可溶性细胞间粘附分子-1(s ICAM-1)联合高迁移率族蛋白B1(HMGB1)预测急性阑尾炎(AA)患儿手术切口感染风险的价值。方法:前瞻性选取2020年1月~2022年7月四川大学华西医院小儿外科收治的536例接受腹腔镜手术的AA患儿,根据术后是否发生手术切口感染分为感染组和未感染组。采用酶联免疫吸附法检测血清PCT、s ICAM-1、HMGB1水平。采用多因素Logistic回归分析AA患儿手术切口感染的影响因素,采用受试者工作特征(ROC)曲线分析血清PCT、s ICAM-1、HMGB1水平对AA患儿手术切口感染的预测价值。结果:536例AA患儿腹腔镜手术后手术切口感染发生率为11.94%(64/536)。与未感染组比较,感染组血清PCT、s ICAM-1、HMGB1水平升高(P<0.05)。多因素Logistic回归分析显示,病程>24 h、阑尾穿孔、手术操作时间>60 min、留置腹腔引流和PCT、s ICAM-1、HMGB1水平升高为AA患儿手术切口感染的独立危险因素(P<0.05)。ROC曲线分析显示,血清PCT、s ICAM-1联合HMGB1预测AA患儿手术切口感染的曲线下面积(AUC)大于PCT、s ICAM-1、HMGB1单独预测。结论:血清PCT、s ICAM-1、HMGB1水平升高与AA患儿手术切口感染密切相关,血清PCT、s ICAM-1联合HMGB1预测AA患儿手术切口感染的价值较高,可能成为AA患儿手术切口感染的辅助预测指标。

Objective:To investigate the value of serum procalcitonin(PCT)and soluble intercellular adhesion molecule-1(s ICAM-1)combined with high mobility group protein B1(HMGB1)in predicting the risk of surgical incision infection in children with acute appendicitis(AA).Methods:536 children with AA undergoing laparoscopic surgical resection who were admitted to the Department of Pediatric Surgery,West China Hospital of Sichuan University from January 2020 to July 2022 were prospectively selected,and they were divided into infected group and uninfected group according to whether postoperative surgical incision infection occurred.Serum PCT,s ICAM-1 and HMGB1 levels were detected by enzyme-linked immunosorbent assay.Multivariate Logistic regression was used to analyze the influencing factors of surgical incision infection in children with AA,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum PCT,s ICAM-1 and HMGB1 levels on surgical incision infection in children with AA.Results:The incidence of surgical incision infection after laparoscopic surgery in 536 children with AA was 11.94%(64/536).Compared with uninfected group,the serum PCT,s ICAM-1 and HMGB1 levels in the infected group increased(P<0.05).Multivariate Logistic regression analysis showed that the duration of disease>24 h,appendix perforation,operation time>60 min,indwelling peritoneal drainage and the elevated PCT,s ICAM-1 and HMGB1 levels were independent risk factors for surgical incision infection in children with AA(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum PCT,s ICAM-1 combined with HMGB1 in predicting surgical incision infection in children with AA was greater than that predicted by PCT,s ICAM-1 and HMGB1 alone.Conclusion:Elevated serum PCT,s ICAM-1 and HMGB1 levels are closely associated with surgical incision infection in children with AA,serum PCT and s ICAM-1 combined with HMGB1 has a high value in predicting surgical incision infection in children with AA,and which may become auxiliary predictors of surgical incision infection in children with AA.