血清降钙素原及其清除率对自体肝移植受者术后早期感染的诊断价值  

The clinical diagnostics value of serum procalcitonin and its clearance rate for infection in liver autotransplantation during perioperative period

作　　者：阿地兰.艾尔肯 王毅[1] 于湘友[1] Adilan Aierken;Wang;Yu Xiangyon(Department of Critical Care Medicine,the First Affiliated Hospital of Xinjiang Medical University,Urumchi 830000,Chin)

机构地区：[1]新疆医科大学第一附属医院重症医学科,乌鲁木齐830000

出　　处：《中华移植杂志（电子版）》2018年第1期9-13,共5页Chinese Journal of Transplantation(Electronic Edition)

基　　金：国家自然科学基金地区科学基金项目(81160232)

摘　　要：目的探究降钙素原(PCT)及降钙素原清除率(PCTc)在自体肝移植受者术后早期感染诊断中的价值。方法选择2015年10月至2017年6月新疆医科大学第一附属医院行自体肝移植术且术后转入ICU的32例受者,根据移植术后9 d内是否发生感染将受者分为感染组(18例)和非感染组(14例)。收集受者一般临床资料及术后第1至9天血清PCT值,计算肝移植术后第3、5、7、9天PCTc。采用两独立样本t检验比较感染组和非感染组受者年龄、APACHEⅡ评分、住院总时间和ICU留治时间。采用秩和检验比较两组受者移植术后第1、3、5、7、9天PCT值及术后第3、5、7、9天PCTc值。采用卡方检验比较两组受者性别。使用受试者工作特征(ROC)曲线评价PCTc对受者肝移植术后早期感染的诊断价值。P<0.05为差异具有统计学意义。结果感染组与非感染组受者术后第3、5、7、9天血清PCT值中位数分别为[13.27(6.25~26.85)]和[5.69(5.21~14.25)]、[20.57(15.65~35.25)]和[5.65(4.52~6.56)]、[25.88(20.36~42.65)]和[5.93(4.72~13.65)]、[30.31(22.21~50.36)]和[6.47(0.94~9.25)]ng/mL,差异均有统计学意义(Z=-2.166、-3.305、-3.400、-3.837,P均<0.05)。感染组与非感染组受者肝移植术后第7、9天PCTc中位数分别为-195%(-548%^-70%)和-23%(-93%~55%)、-223%(-645%^-89%)和-39%(-96%~89%),差异均有统计学意义(Z=-3.001、-3.153,P均<0.05)。肝移植受者术后第3、5、7、9天PCTc预测发生感染的ROC曲线下面积分别为0.708(95%CI:0.517~0.900,P<0.05)、0.778(95%CI:0.614~0.942,P<0.05)、0.813(95%CI:0.665~0.962,P<0.05)、0.829(95%CI:0.689~0.970,P<0.05)。术后第9天PCTc ROC曲线下面积最大。当截断值为-78.04%时,敏感度为85.7%,特异度为73.4%。结论自体肝移植受者术后持续高水平的血清PCT值可能提示感染控制欠佳,连续动态监测PCT和PCTc对病情评估有一定指导意义。Objective To analyzed changes of procalcitonin（PCT） and procalcitonin clearance rate（PCTc） in patient with different outcomes after liver autotransplantation. Methods Thirty-two liver autotransplantation recipients admitted into ICU after transplantation from October 2015 to June2017 were included in this study,all the recipients were divided into in infection group（18 cases） and non-infection group（14 cases） according to the results of etiological examination. The general clinical information and serum PCT value of the first to ninth day after transplantation were collected,and the PCTc of the third,fifth,seventh and ninth day after transplantation were counted. Two independent sample t-test was used to compare the age,APACHE Ⅱ scores,hospital stay and ICU stay of the recipients of the 2 groups. Rank-sum test was used to compare the serum PCT and PCTc of the 2 groups. Chi-square test was used to compare the gender of the 2 groups. Receiver operating characteristic（ROC） curve was used to evaluted the prognosis of recipients of the 2 groups. P〈0. 05 was considered statistically significant. Results The median serum PCT value of the third,the fifth,the seventh and the ninth day after transplantation between infection group and non-infection group were[13. 27（6. 25-26. 85） ]and [5. 69（5. 21-14. 25） ],[20. 57（15. 65-35. 25） ]and [5. 65（4. 52-6. 56） ],[25. 88（20. 36-42. 65） ] and [5. 93（4. 72-13. 65） ],[30. 31（22. 21-50. 36） ] and[6. 47（0. 94-9. 25） ] ng/mL,which all had statistical sinificance（Z =-2. 166,-3. 305,-3. 400,-3. 837,P all 0. 05）. The median PCTc of the seventh and the ninth day after transplantation between infection group and non-infection group were-195%（-548% to-70%）and-23%（-93% to 55%）,-223%（-645% to-89%） and-39%（-96% to 89%）,which all had statistical sinificance（Z =-3. 001,-3. 153,P all 0. 05）. The areas under the ROC curve of the third,the fifth,the seventh and the ninth day after transplantation were 0. 708（95% CI：

关 键 词：自体肝移植 降钙素原 降钙素原清除率 感染 预后 

分 类 号：R657.3[医药卫生—外科学]