sICAM-1、CRP、PCT、D-D在急性化脓性阑尾炎中的表达及其与病原菌、预后的关系研究  

Expression of serum sICAM-1,CRP,PCT and D-dimer in patients with acute suppurative appendicitis and their relationship with pathogens and prognosis

作　　者：邵新华 王国彦[1] 李红卫[1] 宋顺心[1] SHAO Xinhua;WANG Guoyan;LI Hongwei;SONG Shunxin(Department of General Surgery of Chenzhou First People's Hospital,Chenzhou Hunan 423000,China)

机构地区：[1]郴州市第一人民医院普外科,湖南郴州423000

出　　处：《中国急救复苏与灾害医学杂志》2023年第12期1628-1630,1644,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：湖南省自然科学基金(编号:2552)。

摘　　要：目的观察血清可溶性细胞间黏附分子1(sICAM-1)、C反应蛋白(CRP)、降钙素原(PCT)、D二聚体(D-D)在急性化脓性阑尾炎患者中的表达及与病原菌及预后的相关性。方法回顾性分析2020年4月—2021年6月该院收治的急性化脓性阑尾炎患者68例。根据患者病原菌种类及治疗效果来分析血清sICAM-1、CRP、PCT、D-D在急性化脓性阑尾炎患者中表达水平。结果68例患者中共检测出病原菌98株,其中革兰阴性菌68株,占69.39%,革兰阳性菌27株,占27.55%,真菌3珠,占3.06%。感染组患者血清sICAM-1、CRP、PCT、D-D水平均高于非感染组(t=6.730,13.713,7.585,7.688,均P<0.01)。血清sICAM-1、CRP、PCT、D-D水平在G–菌组最高,在真菌组最低,3组间对比差异有统计学意义(F=11.705,9.418、5.079、5.831,均P<0.01);G–菌组血清sICAM-1、CRP、PCT、D-D水平高于G+菌组(t=3.003、6.206、5.645、5.594,均P<0.01)。经抗菌药物治疗后,有效患者44例,无效患者24例。治疗后第1天、第4天无效的患者血清sICAM-1、CRP、PCT、D-D水平均较有效组升高(第1天:t=-1.855、-1.881、-2.301、-2.858,均P<0.05;第4d:t=6.904、-6.827、-3.272、-3.588,均P<0.01)。结论血清sICAM-1、CRP、PCT、D-D可作为G+菌与G-菌血流感染鉴别的重要指标,同时也有助于细菌性感染的诊断与预后评价,指导临床抗菌药物合理应用。Objective To observe the expression of serum Soluble intercellular adhesion molecule-11(sICAM-1),Creactive protein(CRP),procalcitonin(PCT)and D-Dimer(DD)in patients with acute suppurative appendicitis and their correlation with pathogens and prognosis.Methods 68 patients with acute suppurative appendicitis treated in our hospital from April 2020 to June 2021 were analyzed retrospectively.The expression levels of serum sICAM-1,CRP,PCT and D-D in patients with acute suppurative appendicitis were analyzed according to the types of pathogens and therapeutic effects.Results 98 strains of pathogenic bacteria were detected in 68 patients,including 68 strains of Gram-negative bacteria,accounting for 69.39%,27 strains of Gram-positive bacteria,accounting for 27.55%,and 3 beads of fungi,accounting for 3.06%.Serum sICAM-1,CRP,PCT and D-D water in the infected group were higher than those in the non infected group(t=6.730,13.713,7.585,7.688,all P<0.01).The levels of serum sICAM-1,CRP,PCT and D-D were the highest in G-bacteria group and the lowest in fungi group.There was significant difference among the three groups(F=11.705,9.418,5.079 and 5.831,all P<0.01);The levels of serum sICAM-1,CRP,PCT and D-D in G-bacteria group were higher than those in G+bacteria group(t=3.003,6.206,5.645,5.594,all P<0.01).After treatment with antibiotics,44 cases were effective and 24 cases were ineffective.The levels of serum sICAM-1,CRP,PCT and D-D in the ineffective patients on the first and fourth days after treatment were higher than those in the effective group(on the first day:t=-1.855,-1.881,-2.301,-2.858,all P<0.05;on the fourth day:t=6.904,-6.827,-3.272,-3.588,all P<0.01).Conclusion Serum sICAM-1,CRP,PCT and D-D can be used as important indicators to distinguish G+bacteria from G-bacteria bloodstream infection.At the same time,they are also helpful to the diagnosis and prognosis evaluation of bacterial infection,and guide the rational application of clinical antibiotics.

关 键 词：急性化脓性阑尾炎 病原菌 C反应蛋白 降钙素原 D二聚体 可溶性细胞间黏附分子1 

分 类 号：R656.8[医药卫生—外科学]