急性重症胰腺炎合并感染患者降钙素原检测的临床意义

摘要

目的：比较血清降钙素原（procalcitonin ，PCT）、内毒素、C-反应蛋白（C-reaction protein,CRP）水平测定在急性重症胰腺炎(severe acute pancreatitis，SAP)合并感染患者中的早期诊断价值。方法回顾性分析SAP患者80例，根据病人是否存在感染分为感染组(53例)和非感染组(27例)，检测两组患者入院24小时、48小时的PCT、内毒素、CRP水平，同时观察患者的住院天数和住院费用。结果比较入院24小时两组病人的数据，感染组患者血清中PCT水平明显增高，与非感染组比较差异具有统计学意义(P＜0.05)，内毒素和CRP水平增高，但与非感染组比较差异无统计学意义(P＞0.05)；比较入院48小时两组数据，感染组PCT、内毒素、CRP均较非感染组明显升高，差异具有统计学意义(P＜0.05)；对入院24小时诊断为SAP合并感染者，PCT的敏感度为84.91%(45/53)，特异度为92.59%(25/27)，内毒素的敏感度为73.59%(39/53)，特异度为74.07%(20/27)，CRP的敏感度为67.93%(36/53)，特异度为66.67%(18/27)。入院4小时内SAP病人合并感染PCT水平升高者住院天数明显延长，住院费用增加。结论对SAP患者进行血清PCT水平的测定，有助于对SAP病人的病情严重程度进行评估，判断SAP早期合并感染具有重要的临床价值，对SAP的诊断和治疗具有重要的临床指导意义。%Objective To investigate the clinical value of procalcitonin(PCT) determination in the patients with severe acute pancreatitis(SAP) complicated with infection.Methods Eighty patients with SAP were reviewed and eighty patients with SAP were randomly divided into 2 groups , infection group and non-infection group according to the diagnosis criteria of severe acute pancreatitis complicated with infection. 53 patients with severe acute pancreatitis were in infection group and 27 patients were in non-infection group.The PCT level , endotoxin level and C-reaction protein(CRP) level of the patients were determined after 24hr and 48hr during the hospital in these two groups. The mean hospital stay and hospital costs of the patients with SAP were also observed.Results There were signiifcant difference(P<0.05) in the PCT level and endotoxin level between the patients of infection group and the patients of non-infection group. The level of PCT had no correlation with the level of CRP and endotoxin between the patients of infection group and the patients of non-infection group. The sensitivity and speciifcity of PCT were 84.91% and 92.59% respectively in the patients of SAP with infection, the sensitivity and speciifcity of endotoxin were73.59% and 74.07% respectively in the patients of SAP with infection, the sensitivity and specificity of CRP were 67.93% and 66.67% respectively in patients of SAP with infection. The SAP patients with infection with high PCT level would have long hospital stay and much high hospital costs.Conclusion It is helpful to predict early infection and evaluated the risk factors and the prognosis of the SAP patients with complicated with infection to monitoring of the PCT level.This examination would have an obvious clinical value in diagnosis and treatment for the patients with severe acute pancreatitis complicated with infection.