胃癌术后腹腔淀粉酶、C反应蛋白、降钙素原预测临床相关胰瘘发生的准确性分析  

Accuracy analysis of amylase,C-reactive protein and procalcitonin in abdominal cavity of postoperative gastric cancer in predicting the occurrence of clinically related pancreatic fistula

作　　者：田庆[1] 冯勇[1] 刘世江[1] 刘汇明[1] 刘凯[1] 胡晓林[1] Tian Qing;Feng Yong;Liu Shijiang;Liu Huiming;Liu Kai;Hu Xiaolin(Department of General Surgery,Shouguang People's Hospital,Weifang 262700,China)

机构地区：[1]寿光市人民医院普外科,潍坊262700

出　　处：《国际外科学杂志》2022年第5期333-337,I0007,共6页International Journal of Surgery

基　　金：潍坊市卫生健康委科研计划项目(WFWSJK-2020-126)。

摘　　要：目的评估胃癌根治术后早期腹腔淀粉酶、C反应蛋白(CRP)、降钙素原与临床相关胰瘘的关系,探讨其是否可作为胰瘘发生的早期预测指标及其准确性,为术后早期胰瘘的鉴别提供帮助。方法回顾性分析寿光市人民医院2017年1月—2021年12月诊断为胃癌并接受胃切除术的372例患者的临床资料,其中男性190例,女性182例,年龄28~83岁,平均年龄(63.5±10.6)岁。对胃癌术后第1天腹腔淀粉酶、第3天血清CRP和降钙素原进行受试者工作特征(ROC)曲线分析。采用ROC曲线确定最佳截断值,计算最佳临界值的敏感性、特异性、阳性和阴性预测值以及准确度。对影响胃癌术后胰瘘发生的危险因素进行单因素和多因素分析。采用SPSS 25.0软件进行统计分析。结果胃癌术后临床相关胰瘘发病率5.37%(20/372),包括B级胰瘘18例,C级胰瘘2例。胃癌术后预测临床相关胰瘘发生术后第1天淀粉酶临界值为2036 U/L,血清CRP临界值为18 mg/dL,降钙素原临界值为0.85μg/L。单因素分析发现体重指数、胃癌术后第1天腹腔淀粉酶、术后第3天血清CRP及降钙素原均是胃癌术后胰瘘发生的影响因素。多因素Logistic回归分析中,体重指数>25 kg/m^(2)、术后第1天腹腔淀粉酶>2036 U/L和术后第3天血清CRP>18 mg/dL是预测胰瘘发生的独立危险因素。胃癌术后第1天腹腔淀粉酶和第3天血清CRP联合预测临床相关胰瘘发生的敏感性和特异性为87.6%和90.4%。结论胃癌根治术后第1天腹腔淀粉酶和第3天CRP联合预测临床相关胰瘘具有较高的敏感性和特异性。胃癌术后第3天的降钙素原预测临床相关胰瘘的准确度有限,不推荐其作为胃癌术后胰瘘的早期预测指标。Objective To evaluate the relationship between abdominal amylase,C-reactive protein(CRP),procalcitonin(PCT)and clinically relevant pancreatic fistula in the early stage after radical gastrectomy for gastric cancer,and to explore whether they can be used as early predictors of pancreatic fistula and their accuracy,in order to help identify pancreatic fistula in the early stage after gastrectomy.Methods The clinical data of 372 patients diagnosed as gastric cancer and underwent gastrectomy in Shouguang People′s Hospital from January 2017 to December 2021 were retrospectively analyzed,including 190 males and 182 femals,aged from 28 to 32 years old,with the average years of 63.5±10.6.The receiver operating characteristic(ROC)curves of abdominal amylase on the first day and serum CRP and procalcitonin on the third day after surgery for gastric cancer were analyzed.The ROC curve was used to determine the optimal cutoff value and the sensitivity,specificity,positive and negative predictions,and accuracy of the optimal cutoff value were calculated.Single factor and multivariate analysis were used to analyze the risk factors of pancreatic fistula after gastric cancer surgery.SPSS 25.0 software was used for statistical analysis.Results The incidence of clinically relevant pancreatic fistula after surgery for gastric cancer was 5.37%(20/372),including 18 cases of grade B pancreatic fistula and 2 cases of grade C pancreatic fistula.The critical values of amylase on the first postoperative day of clinically relevant pancreatic fistula after surgery for gastric cancer are predicted to be 2036 U/L,serum CRP 18 mg/dL,and procalcitonin 0.85μg/L.In univariate analysis,body mass index,abdominal amylase concentration on the 1st postoperative day,serum CRP and procalcitonin on the 3rd postoperative day were the influencing factors for the occurance of pancreatic fistula after gastric cancer surgery.Multivariate Logistic regression analysis showed that body mass index>25 kg/m^(2),abdominal amylase>2036 U/L on the first postoperati

关 键 词：胃肿瘤 淀粉酶类 C反应蛋白 降钙素原 胰瘘 并发症 

分 类 号：R735.2[医药卫生—肿瘤]