血清降钙素原对急性消化道穿孔部位的预测价值  

Predictive value of serum procalcitonin for the localization of acute digestive tract perforation

作　　者：吕颜智 周业江 Lyu Yanzhi;Zhou Yejiang(Department of Gastrointestinal Surgery,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院胃肠外科,泸州646000

出　　处：《中华急诊医学杂志》2021年第11期1353-1357,共5页Chinese Journal of Emergency Medicine

摘　　要：目的探讨血清降钙素原(procalcitonin,PCT)对急性消化道穿孔部位的预测价值。方法回顾性分析2015年1月至2018年1月于西南医科大学附属医院胃肠外科收治的考虑诊断急性消化道穿孔并行手术治疗的患者88例,根据术中所见以及术后病理检查报告,将患者分为上消化道穿孔组(上消化道组,45例)以及下消化道穿孔组(下消化道组,43例)。分别比较两组消化道穿孔患者的术前降钙素原、血清白细胞(white blood cell,WBC)、中性粒细胞率(neutrophil rate,NEU-R)、C反应蛋白(C reactive protein,CRP)、白蛋白(albumin,ALB)、C反应蛋白/白蛋白比值(C-reactive protein to albumin ratio,CRP/ALB值),采用单因素及多因素logistic回归分析下消化道组的独立危险因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析上述预测标记物对上、下消化道穿孔部位的预测价值。结果单因素分析结果显示,与上消化道组相比较,下消化道组患者血清PCT、CRP、ALB、CRP/ALB值均显著升高(P<0.05)。多因素Logistics回归分析结果显示,PCT、CRP、CRP/ALB值是急性消化道穿孔诊断为下消化道穿孔的独立危险因素(P<0.05)(PCT:OR=1.241,95%CI:1.098~1.403,P=0.001;CRP:OR=0.95,95%CI:0.912~0.99,P=0.014;CRP/ALB值:OR=35.104,95%CI:3.889~316.885,P=0.002)。通过ROC曲线发现,PCT、CRP、CRP/ALB值的曲线下面积(AUC)分别为0.932(95%CI:0.879~0.985)、0.77(95%CI:0.667~0.872)、0.898(95%CI:0.827~0.969);PCT最佳截断值为16.595 ng/mL,其敏感度和特异度分别为86%、91.1%,CRP最佳截断值为55.4 mg/mL,其敏感度和特异度分别为76.7%、80.0%,CRP/ALB最佳截断值为1.45,敏感度和特异度分别为83.7%、88.9%。结论血清PCT、CRP、CRP/ALB值均有助于预测消化道穿孔部位,能提高穿孔部位诊断的正确率,且PCT诊断效能优于CRP、CRP/ALB比值,具有很好的临床价值。Objective To investigate the predictive value of serum procalcitonin(PCT)for the localization of acute digestive tract perforation.Methods This retrospective study included 88 patients from the Department of Gastrointestinal Surgery of the First Affiliated Hospital of Southwest Medical University who were diagnosed as acute digestive tract perforation between January 2015 and January 2018.According to the intraoperative diagnosis and postoperative pathological reports,the enrolled patients were divided into the upper digestive tract perforation group(45 cases)and the lower digestive tract perforation group(43 cases)(above or below Treitz ligament).Preoperative serum PCT,white blood cell,neutrophil rate,C-reactive protein(CRP),albumin(ALB),C-reactive protein to albumin(CRP/ALB)ratio were measured and compared between the two groups.Univariate analysis and multivariate logistic regression analysis were used to analyze the independent risk factors of the lower digestive tract perforation group,and the receiver operating characteristic curve was used to analyze the predictive value of the above mentioned markers in the localization of acute digestive tract perforation.Results Univariate analysis showed that patients in the lower digestive tract perforation group exhibited significantly higher levels of serum PCT,CRP,ALB,and CRP/ALB ratio than patients in the upper digestive tract perforation group(P<0.05).Multivariate logistic regression analysis showed that serum PCT,CRP and CRP/ALB ratio were independent risk factors for the diagnosis of lower digestive tract perforation[PCT:odds ratio(OR)=1.241,95%confidence interval(95%CI):1.098~1.403,P=0.001;CRP:OR=0.95,95%CI:0.912~0.99,P=0.014;and CRP/ALB ratio:OR=35.104,95%CI:3.889-316.885,P=0.002].The area under curve of serum PCT,CRP,CRP/ALB ratio to distinguish upper or lower digestive tract perforation were 0.932(95%CI:0.879~0.985),0.77(95%CI:0.667~0.872),and 0.898(95%CI:0.827~0.969),respectively.The optimal cutoff value of PCT in differential diagnosis of upper or lower d

关 键 词：急性消化道穿孔 降钙素原 C反应蛋白 C反应蛋白/白蛋白比值 预测价值 

分 类 号：R57[医药卫生—消化系统]