食管胃底静脉曲张内镜治疗后血浆内毒素及降钙素原的测定及临床意义  

Measurement of plasma endotoxin and procalcitonin after endoscopic treatment of esophagogastric varices in liver cirrhotic patients and the clinical significance

作　　者：张兴光 冯志杰[2] 蒋树林[2] 刘丽[2] 梁密云 田慧[2] 时晓冬[2] 马会会[2] 姜慧卿[2] 

机构地区：[1] 中国人民武警警察部队后勤学院附属医院消化内科 [2]河北医科大学第二医院消化内科,石家庄050000

出　　处：《中华消化内镜杂志》2015年第3期171-174,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的：研究食管胃底静脉曲张患者内镜治疗前后血浆内毒素及降钙素原水平的变化，为抗生素的应用提供理论基础。方法50例食管胃底静脉曲张患者进行内镜治疗，按照治疗后是否应用抗生素，分为抗生素治疗组（32例）及非抗生素对照组（18例）。于术前、术后1 d、7 d 测定血浆内毒素和降钙素原水平。结果抗生素组血浆内毒素和降钙素原水平在术后1 d、7 d 与术前比较差异无统计学意义；非抗生素组术后1 d 与术前相比无差异，术后7 d 与术前比较均明显升高（P ＜0.05），其中 Child-Pugh A 级患者血浆内毒素水平术后7 d 与术前相比明显增高（P ＜0.01），术后1 d、7 d 降钙素原水平较术前无明显差异，而 Child-Pugh（B ＋C）级患者术后7 d 内毒素和降钙素原较术前均明显增高（P ＜0.01）。结论非抗生素组食管胃静脉曲张内镜治疗术后血浆内毒素及降钙素原水平增加，提示存在感染的风险，特别是对肝功能损伤较重的 Child-Pugh B、C 级患者，术后应考虑预防性应用抗生素。Objective To study the changes of plasma endotoxin and procalcitonin in patients with esophagogastric varices and provide a theoretical basis for prophylactic antibiotics after endoscopic treatment. Methods Fifty cases of patients with esophageal and gastric varices accepted the endoscopic treatment.The patients were divided into antibiotic group （32 cases）and non-antibiotic group （18 cases）.The plasma endotoxin and procalcitonin were measured before and on the first day and 7th day after endoscopic treatment.Results The plasma levels of endotoxin and procalcitonin were not significantly different on the first and 7th day after endoscopic treatment compared with preoperative levels in antibiotic group.But in non-antibiotic group,the levels significantly increased on 7th day after endoscopic treatment compared with preoperative levels （P〈0.05）.And in patients of Child-Pugh A grade,the level of plasma procalcitonin significantly increased on 7th day after endoscopic treatment compared with preoperative levels （P〈0.01）, but the procalcitonin was not significantly different on the first and 7th day after operation.And in patients of Child-Pugh B and C grades,the levels of plasma endotoxin and procalcitonin significantly increased on the 7th day（P〈0.01）.Conclusion The levels of plasma endotoxin and procalcitonin in non-antibiotic group increase after endoscopic treatment,which suggests the risk of infection.Prophylactic antibiotics after endo-scopic treatment should be considered for the patients of Child-Pugh B and C grades.

关 键 词：食管和胃静脉曲张 胃肠内窥镜 内毒素类 降钙素 

分 类 号：R575.2[医药卫生—消化系统]