血清CRP、AAG、CER和Hp在胆管术后感染监测中的价值  

Diagnostic Value of Serum CRP,AAG,CER and Hp in Monitoring Postoperative Infection of Biliary Tract

作　　者：张晓帮[1] 鲍舟君[1] 姚燕珍[1] 安明和[1] 方国安[1] 

机构地区：[1]浙江省舟山医院检验科,316004

出　　处：《医学研究杂志》2013年第5期138-140,共3页Journal of Medical Research

基　　金：舟山市医药卫生科技计划基金资助项目(2009B06)

摘　　要：目的探讨C反应蛋白(C reactive protein,CRP)、α1-酸性糖蛋白(α1-acidglycoprotein,AAG)、血浆铜蓝蛋白(cer-uloplasmin,CER)、触珠蛋白(haptoglobin,Hp)等急性时相蛋白在胆管术后感染监测中的价值。方法选取35例胆汁细菌培养阳性的胆管感染患者作为实验组、选取40例细菌性肺炎作为细菌性感染对照组、21例病毒性肝炎患者作为病毒性感染对照组,以及19例健康个体作为正常对照组,分别抽取空腹静脉血3ml,采用免疫速率比浊法定量检测血清CRP、AAG、CER、Hp的水平,对4项指标在各组间的差异、以及在鉴别细菌性感染与非细菌性感染中的价值进行统计学分析。结果 CRP、AAG和Hp在胆管感染和细菌性肺炎组均明显高于病毒性肝炎和正常对照组(P<0.05),其中CRP和Hp在胆管感染和细菌性肺炎组间均无统计学意义上的差异(P>0.05)、AAG在细菌性肺炎组较高(t=2.018,P=0.047),CRP在病毒性肝炎和正常对照组间无统计学意义上的差异(P>0.05)、AAG和Hp则在正常对照组较高(P<0.05)。CER在胆管感染组中明显高于细菌性肺炎组(t=3.757,P=0.000),而细菌性肺炎组又高于病毒性肝炎组(t=2.157,P=0.035),但正常对照组和细菌性肺炎组之间无统计学意义上的差异(t=0.142,P=0.888);当CRP测定值>7.20mg/L时,在鉴别细菌性和非细菌性感染上的特异性和敏感度分别为90.0%和90.7%;Hp测定值>1.20g/L时,分别为92.5%和74.7%;AAG测定值>0.82g/L时,分别为82.5%和84.0%;CER测定值>0.37g/L时,分别为65.0%和73.3%。结论在胆管术后感染监测中,急性时相蛋白中以CRP在增高幅度、诊断细菌性感染的特异性和敏感度方面价值最高,而AAG、CER和Hp的诊断价值不大。Objective To investigate the diagnostic value of serum CRP（ C reactive protein）, AAG（ α1- acidglycoprotein）, CER （ceruloplasmin） and Hp（haptoglobin） in monitoring postoperative infection of biliary tract. Methods The serum levels of CRP, AAG, CER and Hp were measured using immunonephelometry assay in 4 groups of patients, 35 cases with biliary tract postoperative infection whose bile bacterial culture were positive, 40 cases with bacterial pneumonia, 21 cases with virus hepatitis and 30 healthy individuals. The difference of the serum levels of the four proteins between 4 groups, and their diagnostic values in distinguishing bacterial from nonbacterial infection were analyzed statistically. Results The serum level of CRP,AAG and Hp were significantly increased in groups of biliary tract postoperative infection and bacterial pneumonia, as compared to groups of virus hepatitis and healthy individuals （ P 〈 0.05 ）. Between groups of biliary tract infection and bacterial pneumonia, no difference could be seen in the level of CRP or Hp（P 〉 O. 05） , but AAG was significantly increased in the group of bacterial pneumonia（ t = 2. 018 ,P = 0. 047）. Between groups of virus hepatitis and health individuals, no difference could be seen in the level of CRP（P 〉 0.05 ） , but AAG and Hp were significantly increased in the group of healthy individuals （P 〈 0.05 ）. As compared to the group of virus hepatitis, CER increased significantly in groups of bacterial pneumonia and biliary tract infection（P 〈 0.05）. When Youden index got the maximal value, the specificity and sensitivity of CRP, Hp, AAG and CER in distinguishing bacterial from non - bacterial infection were 90.0% and 90.7% ,92.5% and 74.7% ,82.5% and 84.0% ,65.0% and 73.3% , respectively. Conclusion Of the four acute phase proteins, the diagnostic value of CRP is greatest, and should be detected prior to Hp, AAG and CER in monitoring bacterial infection in afteroperation of biliary tract.

关 键 词：胆管 术后感染 C反应蛋白 α1-酸性糖蛋白血浆铜蓝蛋白触珠蛋白 

分 类 号：R631.4[医药卫生—外科学]