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中华普通外科学文献(电子版) ›› 2018, Vol. 12 ›› Issue (04) : 228 -232. doi: 10.3877/cma.j.issn.1674-0793.2018.04.004

所属专题: 文献

论著

降钙素原与C反应蛋白在预测结直肠癌手术后吻合口瘘的临床价值
吴国刚1,(), 刘兆润1, 冷梅1, 王明辉1, 刘吉盛1, 富民1   
  1. 1. 114002 鞍山,鞍钢集团总医院普通外科
  • 收稿日期:2018-01-11 出版日期:2018-08-01
  • 通信作者: 吴国刚

Clinical value of procalcitonin and C-reactive protein in predicting anastomotic fistula after operation of colorectal cancer

Guogang Wu1,(), Zhaorun Liu1, Mei Leng1, Minghui Wang1, Jisheng Liu1, Min Fu1   

  1. 1. Department of General Surgery, Anshan Iron and Steel Group General Hospital, Anshan 114002, China
  • Received:2018-01-11 Published:2018-08-01
  • Corresponding author: Guogang Wu
  • About author:
    Corresponding author: Wu Guogang, Email:
引用本文:

吴国刚, 刘兆润, 冷梅, 王明辉, 刘吉盛, 富民. 降钙素原与C反应蛋白在预测结直肠癌手术后吻合口瘘的临床价值[J/OL]. 中华普通外科学文献(电子版), 2018, 12(04): 228-232.

Guogang Wu, Zhaorun Liu, Mei Leng, Minghui Wang, Jisheng Liu, Min Fu. Clinical value of procalcitonin and C-reactive protein in predicting anastomotic fistula after operation of colorectal cancer[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2018, 12(04): 228-232.

目的

验证降钙素原(PCT)与C反应蛋白(CRP)可否作为吻合口瘘(AL)早期预测指标,并确定最佳临界值,为结直肠癌术后AL的早期识别提供帮助。

方法

收集2013年1月至2017年4月鞍钢集团总医院收治的408例结直肠癌手术患者为研究对象,于术后第3、5天检测PCT、CRP质量浓度及白细胞计数(WBC),记录患者手术方式、术后出现AL及其他并发症,比较术后第3、5天AL组与非瘘并发症组、无并发症组的PCT、CRP、WBC水平差异。根据ROC曲线比较PCT、CRP、WBC对AL的预测准确性,并计算其敏感度、特异度、联合敏感度、联合特异度、阴性预测值、阳性预测值及最佳临界值。

结果

19例出现AL,术后第3、5天AL组的PCT、CRP值均高于非瘘并发症组及无并发症组(P<0.05),术后第3天PCT、CRP的ROC曲线AUC分别为0.773、0.839,术后第5天PCT、CRP的ROC曲线AUC分别为0.893、0.863。第5天PCT、CRP预测AL的准确性均优于第3天。术后第5天PCT最佳临界值为2.15 μg/L,AL阴性预测值为96.4%,阳性预测值为32.1%,敏感度为84.2%,特异度为90.7%。术后第5天CRP最佳临界值为129.5 mg/L,AL阴性预测值为95.7%,阳性预测值为19.6%,敏感度为94.7%,特异度为77.6%。联合术后第5天PCT和CRP预测AL的敏感度和特异度分别为100.0%、70.4%。

结论

PCT和CRP是结直肠癌手术后早期诊断AL的有价值的指标,术后第5天联合检测PCT和CRP更加有助于AL预测。

Objective

To verify whether procalcitonin (PCT) and C-reactive protein (CRP) can be used as an early predictor of anastomotic leakage (AL) and determine the optimal cut-off value, so as to provide evidence for early identification of AL after colorectal cancer surgery.

Methods

From January 2013 to April 2017, four hundred and eight cases undergoing colorectal cancer operation in Anshan Iron and Steel Group General Hospital were selected. The concentration of PCT, CRP and the white cell count (WBC) were detected 3, 5 d after operation (POD). The methods of operation, AL and other complications after operation were recorded. The differences of PCT, CRP and WBC levels among the AL group, the non-AL group and the non-complication group were compared on 3rd, 5th POD. According to the ROC curve, the prediction accuracy of PCT, CRP and WBC for AL were compared, and their sensitivity (SE), specificity (SP), joint sensitivity, joint specificity, negative predictive value (NPV), positive predictive value (PPV), the best critical value were also calculated.

Results

AL occurred in 19 cases, and the PCT and CRP values of the AL group were higher than the other two groups (P<0.05). The AUC of PCT and CRP was 0.773 and 0.839 on 3rd POD, and 0.893 and 0.863 on 5th POD, respectively. The prediction accuracy of the 5th POD was better than that of the 3rd POD for AL. The optimal cut-off value of PCT on 5th POD was 2.15 g/L, and NPV, PPV, SE, and SP of AL were 96.4%, 32.1%, 84.2% and 90.7%, respectively. The optimal cut-off value of CRP on 5th POD was 129.5 mg/L, NPV, PPV, SE, and SP of AL were 95.7%, 19.6%, 94.7% and 77.6%, respectively. A joint-detection of PCT and CRP could provide higher SE and SP up to 100.0% and 70.4%, respectively.

Conclusions

PCT and CRP are valuable indicators for early diagnosis of AL after colorectal surgery. Combined detection of PCT and CRP on 5th POD may be more conducive to the prediction of AL.

表1 408例结直肠癌患者术后第3、5天PCT、CRP质量浓度和WBC计数比较(±s
图1 三组结直肠癌术后第3天PCT、CRP质量浓度箱式图 其中A为降钙素原(PCT)比较,B为C反应蛋白(CRP)比较;* PCT组数据中的异常值;o CRP组数据中的异常值
图2 三组结直肠癌术后第5天PCT、CRP质量浓度箱式图 其中A为降钙素原(PCT)比较,B为C反应蛋白(CRP)比较;* PCT组数据中的异常值;o CRP组数据中的异常值
表2 结直肠癌患者术后PCT及CRP预测吻合口瘘的ROC曲线分析
图3 三组结直肠癌术后第3、5天PCT、CRP质量浓度和WBC计数的ROC曲线图 其中A为术后第3天,B为术后第5天,降钙素原(PCT),C反应蛋白(CRP),白细胞(WBC)
[1]
徐谊,赵晓牧,孙武青, 等. 直肠癌低位前切除术后吻合口瘘发生相关因素分析[J]. 首都医科大学学报, 2017, 38(5): 727-732.
[2]
Reisinger KW, Poeze M, Hulsewé KW, et al. Accurate prediction of anastomotic leakage after colorectal surgery using plasma markers for intestinal damage and inflammation[J]. J Am Coll Surg, 2014, 219(4): 744-751.
[3]
Adams K, Papagrigoriadis S. Little consensus in either definition or diagnosis of a lower gastro-intestinal anastomotic leak amongst colorectal surgeons[J]. Int J Colorectal Dis, 2013, 28(7): 967-971.
[4]
Giaccaglia V, Salvi PF, Cunsolo GV, et al. Procalcitonin, as an early biomarker of colorectal anastomotic leak, facilitates enhanced recovery after surgery[J]. J Crit Care, 2014, 29(4): 528-532.
[5]
Meyer ZC, Schreinemakers JM, de Waal RA, et al. Searching for predictors of surgical complications in critically ill surgery patients in the intensive care unit : a review[J]. Surg Today, 2015, 45(9): 1091-1101.
[6]
Yang SK, Xiao L, Zhang H, et al. Significance of serum procalcitonin as biomarker for detection of bacterial peritonitis: a systematic review and meta-analysis[J]. BMC Infect Dis, 2014, 14: 452.
[7]
徐益萍,骆方军,郑军, 等. 重症急性胰腺炎患者血清降钙素原与C-反应蛋白测定的临床价值[J].中华医院感染学杂志, 2017, 27(5): 1089-1092.
[8]
王郝,崔娜,牛芳, 等. 降钙素原对心脏外科术后重症患者感染的早期预测价值[J]. 中华危重病急救医学, 2017, 29(10): 897-901.
[9]
宇世飞,李芳秋. 降钙素原的临床应用进展[J]. 医学研究生学报, 2016, 29(2): 206-209.
[10]
Vaziri M, Ehsanipour F, Pazouki A, et al. Evaluation of procalcitonin as a biomarker of diagnosis, severity and postoperative complications in adult patients with acute appendicitis[J]. Med J Islam Repub Iran, 2014, 28: 50.
[11]
冯明明. 血清PCT对结直肠癌术后感染性并发症的诊断价值[J]. 中国现代医学杂志, 2017, 27(7): 112-116.
[12]
Garcia-Granero A, Frasson M, Flor-Lorente B, et al. Procalcitonin and C-reactive protein as early predictors of anastomotic leak in colorectal surgery: a prospective observational study[J]. Dis Colon Rectum, 2013, 56(4): 475-483.
[13]
Silvestre J, Rebanda J, Lourenço C, et al. Diagnostic accuracy of C-reactive protein and procalcitonin in the early detection of infection after elective colorectal surgery- a pilot study[J]. BMC Infect Dis, 2014, 14: 444.
[14]
夏恒,陈福森,孙玲玲, 等. C-反应蛋白对普外科患者手术后腹腔感染性并发症的预测效果[J]. 中华医院感染学杂志, 2017, 27(11): 2539-2542.
[15]
崔潇龙,黄河,郭云童, 等. C反应蛋白在结直肠癌术后吻合口瘘早期预测的临床价值[J]. 中国药物与临床, 2016, 16(9): 1356-1358.
[16]
Ortega-Deballon P, Radais F, Facy O, et al. C-reactive protein is an early predictor of septic complications after elective colorectal surgery[J]. World J Surg, 2010, 34(4): 808-814.
[17]
Scepanovic MS, Kovacevic B, Cijan V, et al. C-reactive protein as an early predictor for anastomotic leakage in elective abdominal surgery[J]. Tech Coloproctol, 2013, 17(5): 541-547.
[18]
Singh PP, Zeng IS, Srinivasa S, et al. Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery[J]. Br J Surg, 2014, 101(4): 339-346.
[19]
Lagoutte N, Facy O, Ravoire A, et al. C-reactive protein and procalcitonin for the early detection of anastomotic leakage after elective colorectal surgery: pilot study in 100 patients[J]. J Visc Surg, 2012, 149(5): e345-349.
[20]
Oberhofer D, Rumenjak V, Lazić J, et al. Inflammatory indicators in patients after surgery of the large intestine[J]. Acta Med Croatica, 2006, 60(5): 429-433.
[21]
Platell C, Barwood N, Dorfmann G, et al. The incidence of anastomotic leaks in patients undergoing colorectal surgery[J]. Colorectal Dis, 2006, 9(1): 71-79.
[22]
蒋锐,彭厚坤,王琳, 等. 腹腔镜直肠癌术后吻合口漏的临床分析及对策(附8例报告)[J]. 中国微创外科杂志, 2017, 17(7): 662-664.
[23]
吴红杰,邹小明. 结直肠癌术后吻合口瘘的诊治及预防[J/CD]. 中华结直肠疾病电子杂志, 2016, 5(2): 171-174.
[24]
李思源,赵鹏,李洪波, 等. 结直肠癌术后吻合口瘘的危险因素分析[J]. 中国现代普通外科进展, 2015, 18(2): 163-164.
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