降钙素原早期变化率在评估复杂性腹腔感染术后感染控制中的作用  

Procalcitonin changes for predicting post-operative infection control in patients with complicated intra-abdominal infections

作　　者：石岩[1] 徐英春 杜微[1] 芮曦[1] 刘晔[1] 王瑶 李素玮[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院ICU,100730 [2]检验科

出　　处：《中国感染与化疗杂志》2012年第4期291-296,共6页Chinese Journal of Infection and Chemotherapy

摘　　要：目的观察复杂性腹腔感染患者术后降钙素原(PCT)的变化规律,探索其在评估感染控制中的作用。方法前瞻性研究2009年因复杂性腹腔感染接受手术治疗而入住ICU的患者,在术后第1周逐日测定血PCT,比较感染成功控制组和控制不良组间PCT的变化规律以及PCT早期变化在预测感染控制中的作用。结果 101例符合入选标准,67例满足最终分析,其中成功控制感染组44例,控制不良组23例,最终死亡7例,均为控制不良组。成功控制感染组与控制不良组术后前3 d的PCT均高于正常水平且组间无差异,分别为6.17比7.80、4.48比6.47和3.70比6.16 pg/L(P>0.05);两组间72 h PCT的变化率差异显著,为46.8%比2.1%(P=0.000)。多元回归分析显示,72 h PCT的变化率(OR=5.1,95%CI 2.1～7.7,P=0.019)及APACHEⅡ评分(OR=3.4,95%CI 1.8～6.8,P=0.031)是感染控制不良的独立危险因素。PCT变化率预测成功控制感染的受试者工作曲线下面积(AUC_(ROC))为0.889,特别是对72 h APACHEⅡ评分仍>1 5分的患者,预测能力进一步提高,AUC_(ROC)为0.955(P=0.000)。结论手术后患者PCT普遍升高,72 h PCT的变化率有助于临床判断感染控制情况,特别是在严重感染的患者中,优于PCT绝对值及传统指标。Abstract： Objective To examine if the early change of procalcitonin （PCT） is helpful for evaluatiag the control of abdominal infection by surgical operation. Methods A prospective, single center observational study was cor ducted in the patients with complicated intra-abdominal infection who were admitted to ICU from January to December 2009. PCT was determined once daily since the first day following operation. The early change of PCT after operation was compared between the patients whose infection was successfully controlled and those without adequate control. Results A total of 101 patients were eligible for inclu- sion in this analysis, of which 67 were evaluable. The infection was persistent in 23 patients. The infection was successfully eradicated in 44 patients. Fatal outcome was reported in 7 patients, all in the group with persistent infection. Increased PCT level was documented in the first 3 days. No significant difference was found between the patients with persistent infection and those whose infection was successfully eradicated （median level 6.17 vs 7.80, 4.48 vs 6.47, 3.70 vs 6.16 pg/L, on the first 3 days respectively, all P〉0.05）. But the percent change of PCT within the first 72 hours were significantly different between the two group （46.8% vs 2.1 %, P = 0. 000）. Multivariate analysis showed that the following factors were associated with per- sistent infection, including the percent change of PCT within the first 72 hours （odds ratio 5.1, P = 0. 019） and APACHE Ⅱ score （odds ratio 3.4, P = 0. 031）. The area under receiver operating characteristics （AUCRoc） for the percent change of PCT within the first 72 hours was 0. 889 for predicting persistent infection. Especially, for the patients whose APACHE Ⅱ scorewas 〉15, the AUCRoc was 0.955 （P = 0. 000）, suggesting higher diagnostic value. Conclusions PCT level increases after operation in the patients with complicated intra-abdomi- nal infection. The percent change of PCT within the first 72 hours following

关 键 词：复杂性腹腔感染 降钙素原 

分 类 号：R656[医药卫生—外科学]