摘要
目的探讨降钙素原（PCT）对小儿活体肝移植术后早期细菌感染诊断的临床价值。方法回顾性分析2013年6月至2015年12月首都医科大学附属北京友谊医院重症医学科收治的接受肝移植患儿的相关临床资料，将患儿分为感染组（60例）和非感染组（100例），记录患儿原发疾病，入科后5d（感染组记录至第9天）PCT水平、体温、白细胞计数、移植肝脏冷、热缺血时间、手术时间、术中失血量进行比较。绘制受试者工作特征曲线（ROC曲线）用于相关参数诊断价值评估。结果所有肝移植术后患儿血PCT水平均有升高，非感染组患儿PCT值在48～72h内恢复至正常水平。感染组患儿PCT峰值[（4．62±1．39）ng／ml]明显高于非感染组[（0．85±0．19）ng／ml]，t=26．56，P=0．00，差异有统计学意义。ROC曲线分析显示高水平的PCT峰值对细菌感染有显著性诊断价值（AUC=0．985）。感染组与非感染组相比，移植肝脏的冷缺血时间[（109．92±19．22）min和（108．04±13．20）min，t=1．05，P=0．29]、热缺血时间（1．49±0．17）min和（1．52±0．12）min，t=1．08，P=0．28]、手术时间[（8．01±0．77）h和（8．00±1．05）h，t=0．06，P=0．94]、手术后第1天白细胞数[（8．95±1．69）×10^9／L和（8．98±2．00）×10^9／L，t=-0．08，P=0．93]及体温[（37．5±0．7）℃和（37．5±0．8）℃，t=-0．05，P=0．96]差异无统计学意义。感染组患儿术中失血量明显多于非感染组[（650．87±90．36）ml和（240．29±67．67）ml，t=32．33，P=0．00]，住ICU时间（天）明显延长[（11．01±1．81）d和（6．03±1．65）d，t=17．78，P=0．00]。结论降钙素原对接受活体肝移植的患儿术后早期细菌感染具有良好的诊断价值。
Objective To analyze the diagnostic value of serum procalcitonin （PCT） for early postoperative bacterial infection after pediatric living donor liver transplantation. Methods A retrospective study was conducted in pediatric patients after living donor liver transplantation recipients admitted to department of critical care medicine of Beijing Friendship Hospital affiliated to Capital Medical University during June 2013 to October 2015. According to the clinical data, all pediatric patients were divided into infection group（n =60） and non-infection group （n = 100）. Primary disease, PCT post operation day 1 to day 5 for non-infection group and day 1 to day 9 for infection group, temperature, white blood cell, cold ischemia time, warm ischemia time, operation time, volume of blood loss during operation were recorded. All parameters above were compared between groups. Receiver operating characteristic （ ROC ） curve was plotted, a,d the diagnostic value of PCT was evaluated. Results PCT of both groups were elevated after liver transplantation, there was a markedly resolution in non-infection group within 48 to 72 hours. PCT of pediatric patients with bacterial infection was significantly higher than that of non-infected patients, and the difference was of greatly significant （ 4. 62 ± 1.39 ） ng/ml vs （ 0. 85 ± 0. 19 ） ng/ml, t = 26. 56, P = 0. 00. ROC curve showed that the peak level of PCT might be valuable in the diagnosis of bacterial infection（ AUC = 0. 985）. There was no significant difference of cold ischemia time [ （ 109.92 ± 19. 22） rain vs （ 108.04 ± 13.20） min, t=1.05, P=0.29], warm ischemia time [ （1. 49 ± 0.17 ） minvs （1.52±0.12） min, t=1.08, P =0. 28], operation time[ （8. 01 ±0. 77）vs （8.00 ± 1.05） h, t =0. 06, P =0. 94], WBC[ （8. 95 ± 1.69） ×10^9/L vs （8.98 ±2. 00） ×10^9/L,t = -0. 08, P =0. 93 ] and body temperature[ （37.5 ±0. 7） vs （37. 5 ± 0. 8） ℃, t = - 0. 05, P = 0. 96 ] on the first day after surgery between infection and non-infection groups. Amount of bleeding in infection group was higher than that of non infection group [ （ 650. 87 ± 90. 36） ml vs （240. 29 ± 67.67 ） ml, t = 32. 33, P = 0. 00 ] , there was longer length of ICU stay in the infection group[（11.01 ±1.81）dvs （6.03±1.65）d, t=17.78, P=0.00]. Conclusion Peak PCTlevel was a valuable indicator for early postoperative bacterial infection after pediatric living donor liver transplantation.
作者
刘景峰
刘培
支德源
段美丽
Liu Jingfeng Liu Pei Zhi Deyuan Duan Meili.(Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China)
出处
《中华检验医学杂志》
CAS
CSCD
北大核心
2017年第1期46-49,共4页
Chinese Journal of Laboratory Medicine
关键词
细菌感染
肝移植
降钙素原
Bacterial infections
Liver transplantation
Proealcitonin
