腹腔镜结直肠癌患者术后血液中C反应蛋白、血清降钙素原结合血清白蛋白预测早期吻合口瘘的临床价值

摘要

目的 探究腹腔镜结直肠癌患者术后血液中C反应蛋白、血清降钙素原结合白蛋白水平与结直肠癌患者术后发生早期吻合口瘘之间的关系及预测价值.方法 选取2013年9月至2015年9月就诊于我科首次诊断为结直肠癌患者136人为研究对象,根据相关诊断标准将术后7日内发生吻合口瘘的患者纳入吻合口瘘组,未发生吻合口瘘的患者纳入非吻合口瘘组.腹腔镜结直肠癌患者术后血液中的C反应蛋白水平采用免疫比浊法测定,血清降钙素原及血清白蛋白水平采用酶联免疫吸附试验测定;记录患者的基线资料,监测术前1d以及术后第12h、1d、3d、5d、7d血液中C反应蛋白水平、血清降钙素原及血清白蛋白水平.结果 对比两组间基线资料及术前1d,差异均无统计学意义(P＞0.05);两组血液C反应蛋白水平在术后12h开始升高,术后5日内呈不断上升趋势,检测至术后第5日时,达到高峰(68.3±28.7/55.7±21.6),且第5日吻合口瘘组血液C反应蛋白水平显著高于非吻合口瘘组(P=0.016＜0.05),二者差异具有统计学意义;两组血清降钙素原水平均在第3日达到高峰,且第3日吻合口瘘组血清降钙素原水平显著高于非吻合口瘘组(P＜0.05),差异具有统计学意义(P=0.000);同时,两组血清白蛋白水平在第3日达到低谷,且第3日吻合口瘘组血清白蛋白水平显著低于非吻合口瘘组(P=0.039);在ROC曲线下血液中C反应蛋白水平的AUC为0.746(95％置信区间:0.650-0.843),其敏感性和特异性分别为92.10％,51.46％.结论 血液中C反应蛋白水平对结直肠癌术后患者早期吻合口瘘预测发生有较好的预测能力,术后同时监测血液中C反应蛋白、血清降钙素原、血清白蛋白三者水平可尽早预测出吻合口瘘发生的可能,有望作为腹腔镜结直肠癌术后患者的常规评估指标而广泛应用于临床.%Objective To explore the relationship between the level of C-reactive protein and combination of serumprocalcitonin andserum albumin after laparoscopic surgery and the risk of early postoperative anastomotic fistula in colorectal cancer patients.Methods The study is based on136 patients with colorectal cancer diagnosed for the first time in our department from September 2013 to September 2015.According to the relevant diagnostic criteria, the patients who had anastomotic fistula within 7 days after the surgery were included in the anastomotic fistula group, while the patients without anastomotic fistula were included in the non-anastomotic fistula group.The levels of C-reactive protein were measured by immune turbidimetry, and procalcitonin levels were measured by enzyme-linked immunosorbent assay (ELISA).We recorded patients' baseline information, and monitored the levels of C-reactive protein, procalcitonin and serum albumin in the blood on the day before operation and 12 h, 1 d, 3 d, 5 dand 7 dafter operation.Results There were no statistically significant differences (P＞0.05) between the two groups of baseline information and preoperative data, and the level of C-reactive protein in the two groups began to rise 12 hours after the operation and continued to increase in 5 days after the operation.The peak (68.3±28.7/55.7±21.6) was detected on the fifth day after the operation, and the level of C-reactive protein in the anastomotic fistula group was significantly higher than that in the non-anastomotic fistula group (P=0.016＜0.05).The levels of procalcitonin in two groups both reached the peak on the third day and the level of procalcitonin on the third day in anastomotic fistula group was significantly higher than that in the non-anastomotic fistula group (P=0.000).Meanwhile, the level of serum albumin in the two groups reached the lowest point on the third day, and the level of serum albumin on the third day in anastomotic fistula group was significantly lower than that in the non-anastomotic fistulagroup (P=0.039).The AUC of the C-reactive protein on the ROC curve was 0.746 (95％ confidence interval:0.650 to 0.843), and the sensitivity and specificity were92.10％ and 51.46％respectively.Conclusion The level of C-reactive protein in the blood is capable to predict early anastomotic fistula among patients with colorectal cancer.Monitoring the level of C-reactive protein, procalcitonin and serum albumin at the same time after the operation can predict the possibility of anastomotic fistula early, which is expected to be the evaluation indexes of patients with colorectal cancer after laparoscopic surgery and widely used in clinical practice.