CRP和MMP-9检测对直肠癌前切除术后吻合口漏的诊断价值  

Value of CRP and MMP-9 detection for diagnosis of anastomotic leakage after rectal cancer anterior resection

作　　者：李明[1] 崔巍[2] 马腾[3] 寇卫军[1] 周亮[1] 寇明文[1] 张文博[1] 

机构地区：[1]解放军第155中心医院普通外科,河南开封475003 [2]解放军第155中心医院检验科,河南开封475003 [3]解放军第155中心医院神经内科,河南开封475003

出　　处：《重庆医学》2017年第25期3506-3508,3511,共4页Chongqing medicine

摘　　要：目的研究连续检测血清和盆腔引流液C反应蛋白(CRP)和引流液基质金属蛋白酶-9(MMP-9)对早期诊断低位直肠癌前切除术后吻合口漏的临床价值。方法 158例行低位直肠癌前切除术的患者,在术后第1、3、5、7天分别测量血清和盆腔引流液中CRP和MMP-9水平。将患者分为吻合口漏组(n=9)和无吻合口漏组(n=149),比较两组测量值的差异。结果 158例患者中发生吻合口漏9例,两组患者血清与引流液CRP检测值与术后天数的相关性分析显示第3、5、7天差异有统计学意义(P<0.05)。ROC曲线分析显示术后第3天血清和引流液CRP连续检测诊断吻合口漏准确性中等,术后第5天和第7天血清和引流液CRP连续检测诊断吻合口漏准确性较高。术后第5天血清CRP高于128.23mg/L和引流液CRP高于89.93mg/L的患者,术后第7天血清CRP高于113.71mg/L和引流液CRP高于81.75mg/L的患者均发生了吻合口漏。无吻合口漏组和吻合口漏组引流液MMP-9检验值组间差异无统计学意义(P>0.05)。结论连续检测血清和引流液CRP水平可用于早期诊断低位直肠癌前切除术后吻合口漏。引流液中MMP-9连续检测与低位直肠癌前切除术后吻合口漏的早期诊断无关。Objective To investigate the clinical value of continuously detecting serum and pelvic drainage fluid C-reactive protein （CRP） and drainage fluid matrix metalloproteinase-9 （MMP-9） in the early diagnosis of anastomotic leakage after anterior resection of low rectal cancer. Methods The levels of CRP and MMP-9 in serum and pelvic drainage fluid were measured on post- operative 1,3,5,7 d in 158 patients with low rectal cancer anterior resection. The patients were divided into the anastomotic group （n= 9） and non-anastomotic leakage group （n= 149）. The differences in the detection values between the two groups were com- pared and analyzed statistically. Results Among 158 eases,anastomotie leakage occurred in 9 eases. The correlation analysis of serum and drainage fluid CRP detection value and postoperative days （POD） in the two groups showed the POD 3,POD 5 and POD 7 difference was statistically significant （P〈0. 05）. The ROC curve analysis showed that the accuracy of the serum and drainage fluid CRP continuous detection for diagnosing the anastomotie leakage on postoperative 3 d was middle, which on postoperative 5,7 d was higher. The patients with CRP detection value 〉 128.23 mg/L and drainage fluid CRP 〉89.93 mg/L on postoperative 5 d and those with CRP detection value〉113.71 mg/L and drainage fluid CRP〉81.75 mg/L on postoperative 7 d developed the anastotootle leakage. The drainage fluid MMP-9 detection value had no statistical difference between the anastomotie leakage group and the non-anastomotie leakage group （P〉0.05）. Conclusion Continuous detection of serum and drainage fluid CRP level can be used for early diagnosing postoperative anastomotie leakage in low rectal cancer anterior resection. The drainage fluid MMP-9 continuous detection has no relation with early diagnosis of anastomotie leakage after low rectal cancer anterior resection.

关 键 词：直肠肿瘤 吻合口漏 C反应蛋白 基质金属蛋白酶-9 

分 类 号：R735.37[医药卫生—肿瘤]