PCT联合D-二聚体、hs-CRP、WBC在非特异性外科感染诊断与治疗中的应用价值  

Effect and application of PCT combined with D-dimer、hs-CRP and WBC on diagnosis and treatment of nonspecific surgical infection

作　　者：黄涛[1] 姚红艳[2] 尔启东 刘汉博[1] 刘书航[1] 张洪印[1] 张勇强[1] 贾学伟 王利军[1] HUANG tao;YAO Hong-yan;ER Qi-dong(Department of general surgery,Xiqing hospital,Tianjin 300380,China;Tianjin medical university clinical medical college,Tianjin 300270,China)

机构地区：[1]天津市西青医院普外科,天津300380 [2]天津医科大学临床医学院,天津300270

出　　处：《吉林医学》2021年第8期1858-1862,共5页Jilin Medical Journal

基　　金：天津市西青医院科研基金项目[项目编号:xqyyky201801]。

摘　　要：目的:探讨降钙素原(PCT)联合D-二聚体、超敏C-反应蛋白(hs-CRP)、白细胞(WBC)对非特异性外科感染性疾病的诊疗影响及应用价值。方法:随机选取2018年3月~2020年2月天津市西青医院外科收治的非特异性外科感染患者280例按疾病炎性指标检测、感染有无以及是否合并全身炎性反应综合征(SIRS)分为3组:感染未合并SIRS 100例为常规组,感染合并SIRS 100例为观察组,非感染80例为对照组。比较3组患者入院24 h、72 h、5~7 d PCT、hs-CRP、WBC、N及D-二聚体的变化以及记录入院24 h菌血症发生率,绘制ROC曲线,计算曲线下面积。结果:入院24 h、72 h常规组患者PCT、hs-CRP、WBC、N较对照组明显升高,差异均有统计学意义(P<0.01),但D-二聚体差异无统计学意义(P>0.05);观察组患者PCT、hs-CRP、WBC、N、D-二聚体较常规组、对照组明显升高,差异均有统计学意义(P<0.01)。在合并SIRS时D-D值升高具有临床意义,可能预示着感染较重。入院5~7 d后各组hs-CRP、WBC、N以及D-二聚体差异无统计学意义(P>0.05),但PCT两两比较(常规组vs观察组,常规组vs对照组,观察组vs对照组)P值为(<0.05、>0.05、<0.05)。感染患者部分病例出现菌血症,合并SIRS时PCT CUT off=5.11 ng/ml,菌血症发生率高达23%。结论:PCT联合hs-CRP、WBC、N等能够增强非特异性外科感染炎性指标诊断敏感性,可以指导临床抗生素应用;PCT≥5.11 ng/ml对于判断严重感染具有重要临床意义;D-二聚体持续升高可能为重症感染提供诊断价值。Objective To investigate the effects of PCT combined with D-dimer,hs-CRP and WBC on the diagnosis and treatment of nonspecific surgical infectious diseases.Method 280 cases of surgical diseases admitted in our hospital from March 2018 to February 2020 were randomly selected and divided into three groups according to the disease inflammation index detection,and whether the infection was detected or not and whether it was complicated with systemic inflammatory response syndrome(SIRS):100 cases(routine group)in the group without SIRS infection,100 cases(observation group)in the group with SIRS infection and 80 cases(control group)in the group without infection.The changes of 24 h,72 h,5~7 d PCT,hs-CRP,WBC,N and D-dimer in three groups were compared and the incidence of bacteremia in the 24 h of admission was recorded,the ROC curve was drawn and the area under the curve was calculated.Results PCT,hs-CRP,WBC and N were significantly increased in the routine group 24 h and 72 h after admission compared with the control group,and the difference was statistically significant(P<0.01).However,there was no significant change in D-dimer,and the difference was not statistically significant(P>0.05).PCT,hs-CRP,WBC,N and D-dimer in the observation group were significantly higher than those in the routine group and the control group,with statistically significant differences(P<0.01).The increase of D-D value in combination with SIRS,that was,when the infection was severe,has clinical significance,and the increase of D-D value may indicate the serious infection.5 to 7 d after admission the hs-CRP,WBC,N and D-dimer were no statistically significant difference(P>0.05),but comparing PCT(routine group vs observation group,routine group vs control group and observation group vs control group),P value was(<0.05,>0.05,<0.05).This indicated that after 5~7 d,the systemic inflammatory response of the SIRS group was alleviated,and the rest of the inflammatory indicators returned to normal,the PCT level remained relatively high.Some of the in

关 键 词：降钙素原 超敏C-反应蛋白 白细胞 D-二聚体 非特异性外科感染 全身炎性反应综合征 

分 类 号：R63[医药卫生—外科学]