重症急性胰腺炎C-反应蛋白、降钙素原、APACHE-Ⅱ评分与并发细菌感染的相关性研究

The changes of C-reactive protein, procalcitonin and APACHE-Ⅱ score and their relationships with complicated bacterial infection in patients with severe acute pancreatitis

目的:探讨重症急性胰腺炎(SAP)患者C-反应蛋白(CRP)、降钙素原(PCT)、APACHE-Ⅱ评分变化与并发细菌感染的关系。方法:按照纳入排除标准回顾性收集2017-01—2018-05期间我院急诊内科及急诊ICU收治的56例SAP患者,根据患者住院病程中是否合并细菌感染,分为非感染组(21例)和感染组(35例),分析患者CRP、PCT、APACHE-Ⅱ评分变化,并探讨三者的变化与并发细菌感染的关系。结果:非感染组和感染组在入院第1天及第3天CRP、PCT、APACHE-Ⅱ评分方面差异无统计学意义,非感染组和感染组在入院1周时CRP、PCT、APACHE-Ⅱ评分及其差值方面差异有统计学意义,ROC曲线结果显示,在评价SAP合并细菌感染的敏感度、特异度、曲线下面积(AUC)方面,CRP差值以-12.02 mg/L为临界值时分别为65.71%、85.71%、0.780,PCT差值以0.21μg/L为临界值时分别为80.00%、71.43%、0.737,APACHE-Ⅱ评分差值以-3为临界值时分别为57.14%、95.24%、0.773,三者联合时分别为68.57%、90.48%、0.864,三者联合与三者单独相比时差异无统计学意义(P>0.05),三者之间差异均无统计学意义(P>0.05)。结论:SAP患者CRP、PCT、及APACHE-Ⅱ评分变化与其并发细菌感染相关,监测三者水平变化可为SAP患者并发细菌感染提供早期理论支持,但三者联合时诊断效能未见明显改善。

Objective:To investigate the changes of C-reactive protein(CRP),procalcitonin(PCT)and APACHE-Ⅱscore and their relationships with complicated bacterial infection in patients with severe acute pancreatitis(SAP).Method:A total of 56 patients with SAP who were admitted and treated in our hospital from January 2017 to May 2018 were enrolled in the study.According to whether or not combined with bacterial infection,these patients were divided into non infection group(n=21)and infection group(n=35).The changes of CRP,PCT and APAECHE-Ⅱscore were detected in both groups.The changes of CRP,PCT,APACHE-Ⅱscore and their relationships with complicated bacterial infection were observed and compared between the two groups.Result:There were no significant differences in the levels of CRP,PCT,APACHE-Ⅱscore at the first day and the third day between two groups(P>0.05).However,the levels of CRP,PCT,APACHE-Ⅱscore had significant differences between two groups at the first week(P<0.05).The ROC curve analysis result showed that in the evaluation of SAP patients combined with bacterial infection,the sensitivity,specificity,and the area under the curve were 65.71%、85.71%、0.780 if taking the CRP difference value of-12.02 mg/L as critical value,80.00%、71.43%、0.737 if taking the PCT difference value of 0.21μg/L as critical value,57.14%、95.24%、0.773 if taking the APAECHE-II score difference value of-3 as critical value,68.57%、90.48%、0.864 when combination.There was no significant statistical difference between the combined three and any individual one.Conclusion:The changes of CRP,PCT,APACHE-Ⅱscore in patients with SAP are related to the bacterial infection.They can be respectively regarded as an important indicator of patients with SAP complicated by bacterial infection.However,the combination of the three indexes can’t effectively improve the diagnostic efficiency.