降钙素原对急性穿孔性阑尾炎的预测作用及手术方式的影响  

作　　者：唐智亮[1] 孙元水[2] 章国良[3] 胡抢 倪海滨[2] 

机构地区：[1]浙江中医药大学,310053 [2]浙江省立同德医院胃肠外科,310012 [3]温州医科大学,325035

出　　处：《浙江临床医学》2017年第3期451-453,共3页Zhejiang Clinical Medical Journal

摘　　要：目的评估降钙素原（PCT）是否可以作为一种快速而可靠的预测急性穿孔性阑尾炎的检测方法，从而指导急诊阑尾切除术的手术时机及不同术式对术后降钙素原的影响。方法行阑尾切除术且术前未使用抗生素的急性阑尾炎患者162例，入院后检测血浆PCT，体温（BT），白细胞计数（WBC）、中性粒细胞百分比与C反应蛋白（CRP）水平。根据病理及手术所见将患者分为穿孔组和未穿孔组。按照手术方式将穿孔组分为腹腔镜手术组和开腹组，观察术后第24h、48h的血清PCT水平。结果BT、WBC、中性粒细胞百分比、CRP、PCT的曲线下面积分别为0．719、0．589、0．609、0．813、0．863。PCT诊断穿孔性阑尾炎价值较其他4个炎症指标高。单变量分析PCT预测穿孔性阑尾炎：血浆PCT〉0．75ng／ml（95％置信区间：0．81-0．92），差异有统计学意义（P〈0．01）。腹腔镜组和开腹组术前PCT差异无统计学意义（P〉0．05），术后24h两组PCT均较术前明显升高（P〈0．05）。术后48h两组PCT均明显下降（P〉0．05），但腹腔镜组PCT较开腹组下降明显（P〈0．05）。结论PCT对穿孔性阑尾炎具有一定的诊断价值且腹腔镜对其影响最小。Objective To explore the role of procalcitonin as a rapid and reliable prediction method of acute perforated appendicitis to guide the emergency appendectomy surgery timing and compare the effect of different operative methods on postoperative procalcitonin concentrition. Methods We retrospectively analyzed 162 patients who underwent appendectomy without receiving antibiotics before admission and had preoperative data on the plasma procalcitonin level （ PCT ） , body temperature （ BT ） , white blood cell count （ WBC ） , neutrophil ratio and C-reactive protein level （ CRP ） . According to pathology and operation findings.Patients were divided into two groups： patients with perforated group and without perforation. According to the operation, perforated group can be divided into laparoscopic appendectomy group （ LA group ） and open appendectomy group （ OA group ） .The blood samples of cases were collected 24h, 48h after the operation. Results The AUC of BT, WBC, neutrophil ratio, CRP and PCT were 0.719, 0.589, 0.609, 0.813, 0.863. The diagnostic accuracy of PCT was higher than other four inflammation index for identifying perforation. Univariate analysis of PCT predicted perforation revealed that a plasma PCT level〉 0.75 ng/mL （ 95%confidence interval： 0.81- 0.92 ） （ P〈0.01 ） . There were no significant difference between LA group and OA group in the preoperative levels of PCT （ P〉0.05 ） compared to preoperative levels, the levels of PCT were significantly increased 24h after surgery in both groups （ P〈0.05 ） .The level of PCT in both groups 48h after operation fell to preoperative levels （P〉0.05 ） .Moreover, the levels of PCT in OA group 48h after operation were significantly higher than those in LA group （ P=0.007 ） . Conclusion These findings indicate that procalcitonin is a useful marker of acute appendicitis with perforation and the changes of PCT after laparoscopic surgery were minor.

关 键 词：降钙素原 C反应蛋白 阑尾炎 阑尾切除术 

分 类 号：R656.41[医药卫生—外科学]