恶性梗阻性黄疸PTCD术后胆道感染危险因素及sCD14-ST诊断价值  

Risk factors for biliary tract infection in malignant obstructive jaundice patients after PTCD and diagnostic value of sCD14-ST

作　　者：范小斌[1] 徐明洲[1] 贾亚鹏 唐洪 王倩[1] FAN Xiao-bin;XU Ming-zhou;JIA Ya-peng;TANG Hong;WANG Qian(The First Affiliated Hospital of Nanyang Medical College,Nanyang,Henan 473000,China)

机构地区：[1]南阳医学高等专科学校第一附属医院介入科,河南南阳473000

出　　处：《中华医院感染学杂志》2021年第2期233-237,共5页Chinese Journal of Nosocomiology

基　　金：河南省科研基金资助项目(2018AK439)。

摘　　要：目的探讨恶性梗阻性黄疸经皮肝穿刺胆管引流术(PTCD)术后胆道感染危险因素及可溶性CD14亚型(sCD14-ST)诊断价值分析。方法选择2017年3月-2020年3月南阳医学高等专科学校第一附属医院外科行PTCD恶性梗阻性黄疸患者192例作为研究对象,根据其术后是否发生胆道感染分为感染组(n=80)及未感染组(n=112)。检测所有患者术前C-反应蛋白(CRP)、降钙素原(PCT)和sCD14-ST水平,采用受试者工作特征曲线(ROC)评价三指标对于PTCD术后胆道感染的诊断价值,单因素及多因素Logistic回归分析PTCD术后胆道感染危险因素。结果感染组患者整体sCD14-ST、CRP和PCT水平均高于未感染组(P<0.05),且随着感染严重程度的加重,sCD14-ST、CRP、PCT水平逐渐升高;ROC分析结果表明,血清sCD14-ST、CRP、PCT对于PTCD术后胆道感染诊断价值的Cut-off值分别为33.57 ng/ml、11.38 mg/L、0.57 ng/ml,其中sCD14-ST曲线下面积最大;多因素Logistic回归分析结果表明,年龄>60岁、术前CONUT评分≥2、有胆道手术史、术前三指标(CRP、PCT和sCD14-ST)水平是恶性梗阻性黄疸患者PTCD术后胆道感染的危险因素(P<0.05)。结论恶性梗阻性黄疸PTCD术后胆道感染危险因素包括年龄、术前CONUT评分≥2、既往胆道手术史、术前CRP、PCT和sCD14-ST指标水平等,应进行针对性预防,sCD14-ST对于判断感染严重程度具有一定价值,值得临床推广。OBJECTIVE To explore the risk factors for postoperative biliary tract infection in malignant obstructive jaundice patients undergoing percutaneous transhepatic choledochus drainage(PTCD)and the diagnostic value of soluble CD14-subtype(sCD14-ST).METHODS A total of 192 patients with malignant obstructive jaundice who underwent PTCD in the First Affiliated Hospital of Nanyang Medical College from Mar.2017 to Mar.2020 were recruited as the study objects and divided into the infection group with 80 cases and the non-infection group with 112 cases according to the status of postoperative biliary tract infection.The levels of C-reactive protein(CRP),procalcitonin(PCT)and sCD14-ST of all the patients were detected before the surgery,the value of the three indexes in diagnosis of postoperative biliary tract infection was analyzed by using receiver operating characteristic(ROC)curve,and univariate analysis and multivariate logistic regression analysis were performed for the risk factors for the postoperative biliary tract infection in the PTCD patients.RESULTS The levels of sCD14-ST,CRP,and PCT of the infection group were significantly higher than those of the non-infection group(P<0.05);the levels of sCD14-ST,CRP and PCT were elevated with the aggravation of infection.ROC analysis showed that the Cut-off values of serum sCD14-ST,CRP and PCT were respectively 33.57ng/ml,11.38mg/L and 0.57ng/ml in diagnosis of postoperative biliary tract infection in the PTCD patients,and the area under curve of the sCD14-ST was the largest.The result of multivariate logistic regression analysis indicated that the more than 60 years of age,preoperative CONUT score no less than 2 points,history of biliary tract surgery and levels of three preoperative indexes were the risk factors for the biliary tract infection in the patients with malignant obstructive jaundice after PTCD(P<0.05).CONCLUSION The risk factors for the postoperative biliary tract infection in the malignant obstructive jaundice patients undergoing PTCD include the age,preoperat

关 键 词：恶性梗阻性黄疸 经皮肝穿刺胆管引流术 胆道感染 可溶性CD14亚型 

分 类 号：R619[医药卫生—外科学]