降钙素原对老年急性重度胆囊炎发生的预测价值  

Predictive value of procalcitonin for incidence of acute severe cholecystitis in elderly patients

作　　者：赵月 田坤 张宗明 郭震天 刘立民 张翀 刘卓 Zhao Yue;Tian Kun;Zhang Zongming;Guo Zhentian;Liu Limin;Zhang Chong;Liu Zhuo(Department of General Surgery,Beijing Electric Power Hospital of State Grid Corporation of China,Beijing 100073,China;Key Laboratory of Geriatrics(Hepatobiliary Diseases)of GENERTEC,Beijing 100073,China;Graduate School of Capital Medical University,Beijing 100073,China)

机构地区：[1]国家电网公司北京电力医院普通外科,100073 [2]中国通用技术集团老年医学(肝胆)重点实验室,北京100073 [3]首都医科大学研究生院,北京100073

出　　处：《中华肝脏外科手术学电子杂志》2024年第6期801-806,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：北京市科技重大专项生物医药与生命科学创新培育研究(Z171100000417056);国中康健集团科技项目(GZKJ-KJXX-QTHT-20230626)

摘　　要：目的探讨降钙素原(PCT)在老年急性胆囊炎严重程度评估中的预测价值。方法回顾性分析2013年7月至2023年8月在国家电网公司北京电力医院行胆囊切除术的243例老年急性胆囊炎患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男111例,女132例;年龄60~92岁,中位年龄68岁。根据东京指南(2018)将患者分为急性轻中度胆囊炎(AMC)组和急性重度胆囊炎(ASC)组。ASC预测单因素分析采用秩和检验和χ^(2)检验,多因素分析采用Logistic多因素回归分析。绘制ROC曲线,通过ROC曲线确定PCT、WBC和高敏C-反应蛋白(Hs-CRP)最佳界值,并计算曲线下面积(AUC)。结果Logistic多因素回归分析显示,胆囊周围或肝周积液(OR=0.258,95%CI:0.102~0.651)、WBC(OR=1.262,95%CI:1.072~1.486)、Hs-CPR(OR=1.020,95%CI:1.012~1.028)、PCT(OR=0.712,95%CI:0.559~0.906)是老年ASC的独立预测因素(P<0.05)。ROC曲线分析显示,肝周或胆囊周围积液诊断老年ASC发生的AUC为0.694(95%CI:0.619~0.769);PCT、WBC和Hs-CRP诊断老年ASC发生的AUC分别为0.835(95%CI:0.784~0.886)、0.875(95%CI:0.827~0.924)和0.876(95%CI:0.828~0.925),最佳界值分别为0.50μg/L、10.9×10^(9)/L和66.2 mg/L;PCT的敏感度及特异度分别为0.89和0.77。四者联合诊断曲线的AUC为0.914,高于单一PCT、Hs-CRP、WBC和胆囊周围或肝周积液的AUC。结论PCT对老年ASC具有良好的诊断效能,联合WBC、Hs-CPR和胆囊周围或肝周积液检测的预测效能更高、评判效果更可靠。Objective To evaluate the value of procalcitonin(PCT)in predicting the severity of acute cholecystitis in elderly patients.Methods Clinical data of 243 elderly patients with acute cholecystitis who underwent cholecystectomy in Beijing Electric Power Hospital of State Grid Corporation of China from July 2013 to August 2023 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,111 patients were male and 132 female,aged 60-92 years,with a median age of 68 years.According to the Tokyo Guidelines(2018),all patients were divided into acute mild and moderate cholecystitis(AMC)group and acute severe cholecystitis(ASC)group.Univariate analysis of ASC prediction was conducted by rank-sum test and Chi-square test.Multivariate analysis was performed by multivariate Logistic regression analysis.The receiver operating characteristic(ROC)curve was delineated to determine the optimal threshold values of PCT,WBC and high-sensitivity C-reactive protein(Hs-CRP).The area under the ROC curve(AUC)was calculated.Results Multivariate Logistic regression analysis showed that perigallbladder or perihepatic effusion(OR=0.258,95%CI:0.102-0.651),WBC(OR=1.262,95%CI:1.072-1.486),Hs-CPR(OR=1.020,95%CI:1.012-1.028)and PCT(OR=0.712,5%CI:0.559-0.906)were the independent predictive factors for ASC in elderly patients(P<0.05).ROC curve analysis showed that the AUC of perihepatic or perigallbladder effusion in the diagnosis of ASC in elderly patients was 0.694(95%CI:0.619-0.769).The AUC of PCT,WBC and Hs-CRP in the diagnosis of ASC in elderly patients was 0.835(95%CI:0.784-0.886),0.875(95%CI:0.827-0.924)and 0.876(95%CI:0.828-0.925),respectively.The optimal threshold values were 0.50μg/L,10.9×10^(9)/L and 66.2 mg/L,respectively.The sensitivity and specificity of PCT were 0.89 and 0.77,respectively.The AUC of these 4 parameters combined in the diagnosis of ASC in elderly patients was 0.914,higher than that of PCT,Hs-CRP,WBC and perigallbladder or perihepatic

关 键 词：老年 胰腺炎 急性 降钙素原 LOGISTIC模型 ROC曲线 

分 类 号：R657.4[医药卫生—外科学]