血浆降钙素原与D-二聚体水平在判断急性胆管炎病情严重程度中的临床价值  

Clinical significance of procalcitonin combined with D-dimer in assessment of the severity of acute cholangitis

作　　者：钱海超[1] 芦照青[1] 张天鹏[1] QIAN Hai-chao;LU Zhao-qing;ZHANG Tian-peng(Departmentof Emergency,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China.)

机构地区：[1]首都医科大学附属北京友谊医院急诊科

出　　处：《临床和实验医学杂志》2019年第18期1949-1952,共4页Journal of Clinical and Experimental Medicine

基　　金：北京市医院管理局临床医学发展专项“扬帆”计划(编号:ZYLX201802)

摘　　要：目的探讨急性胆管炎患者血浆降钙素原(PCT)及D二聚体(DD)水平在判断病情严重程度方面的临床价值。方法回顾性收集2018年1月至2019年2月首都医科大学附属北京友谊医院收治的113例急性胆管炎患者,在初次就诊时进行血浆PCT及DD检测。根据急性胆管炎的严重程度将患者分为三组:轻度急性胆管炎48例(42. 48%),中度急性胆管炎42例(37. 17%),重度急性胆管炎23例(20. 35%)。比较三组患者PCT、DD水平与胆管炎严重程度的相关性。结果 PCT和DD与急性胆管炎患者的严重程度分级相关,PCT的相关系数为0. 667,DD的相关系数为0. 692,重度急性胆管炎患者的PCT及DD水平均高于中度急性胆管炎患者(11. 97 ng/ml vs. 3. 84 ng/ml,11. 87mg/L vs. 3. 54 mg/L,P=0. 000,P=0. 000)及轻度急性胆管炎患者(11. 97 ng/ml vs. 1. 09 ng/ml,11. 87 mg/L vs. 1. 65mg/L,P=0. 000,P=0. 000),PCT诊断重度急性胆管炎的临界值为3. 72 ng/ml(敏感性为87%,特异性为81%),DD诊断重度急性胆管炎的临界值为3. 50 mg/L(敏感性为87%,特异性为79%)。结论血浆PCT及DD水平可作为预测重度急性胆管炎的指标,因此,两者可作为紧急胆道减压的辅助生物标记物。Objective To explore the clinical significance of serum level of procalcitonin( PCT) and D-dimer( DD) in patients with acute cholangitis for assessment of the severity of disease. Methods A retrospective collection of 113 patients with acute cholangitis admitted to this hospital during January 2018 to February 2019 was performed at the initial visit for PCT and DD. These patients were divided into three groups according to the severity of acute cholangitis: 48 cases( 42. 48%) with mild acute cholangitis,42 cases( 37. 17%) with moderate acute cholangitis,and 23 cases( 20. 35%) with severe acute cholangitis. The correlation between PCT and DD levels and the severity of cholangitis was compared between these three groups. Results PCT and DD were associated with the severity of patients with acute cholangitis. The correlation coefficient of PCT was 0. 667,and the correlation coefficient of DD was 0. 692. The PCT and DD levels in patients with severe acute cholangitis were higher than those of moderate acute cholangitis( 11. 97 ng/ml vs. 3. 84 ng/ml,11. 87 mg/L vs. 3. 54 mg/L,P = 0. 000,P = 0. 000) and patients with mild acute cholangitis( 11. 97 ng/ml vs. 1. 09 ng/ml,11. 87 mg/L vs. 1. 65 mg/L,P = 0. 000,P = 0. 000). The cutoff value of PCT for serious condition was 3. 72 ng/ml( sensitivity of 87% and specificity of 81%),the cutoff value of DD for the serious condition was 3. 50 ng/ml( with sensitivity of 87% and specificity of 79%). Conclusion PCT and DD can be used as a promising marker for clinical deterioration in acute cholangitis. Therefore,PCT and DD may be used as a decisive supporting biomarker for urgent biliary decompression.

关 键 词：急性胆管炎 降钙素原 D二聚体 病情严重程度 预测 

分 类 号：R575.7[医药卫生—消化系统]