血清降钙素原与C反应蛋白对于急性胆管炎的临床价值

摘要

目的 分析血清降钙素原(procalcitonin,PCT)与C反应蛋白(C-reactive protein,CRP)对于急性胆管炎(AC)病人的病情评估和临床诊疗价值.方法 回顾性分析2016年3月至2017年7月昆明医科大学第二附属医院肝胆胰外科三病区收治的76例急性胆管炎病人的临床资料.将76例AC病人作为AC组,并且根据其严重程度分为轻度组(n=42)、中重度组(n=34):另选取同时期的患有胆管结石但无感染者72例作为对照组.观察两组病人治疗前后PCT、CRP的变化水平,以及其诊断AC的灵敏度和特异度.绘制受试者工作特征曲线(ROC)来比较PCT与CRP对于AC早期诊断及病情严重评估的能力.结果 治疗前AC组的PCT、CRP水平均高于对照组,差异有统计学意义(P＜0.001);轻度组的PCT、CRP水平均低于中重度组,差异有统计学意义(P＜0.001).经过治疗后血清中的PCT、CRP水平均比治疗前有显著下降,差异有统计学意义(P＜0.001),且PCT检测的敏感性和特异性均优于CRP,差异有统计学意义(P＜0.001).ROC曲线可看出PCT曲线下面积(AUC)为0.81 (95％CI..0.86,0.94),明显高于CRP 0.64(95％CI:0.63,0.77).结论 PCT、CRP均能早期检测AC,且PCT对于早期诊断AC的临床价值高于CRP,具有更高的特异性和灵敏性,更有助于临床评估AC的严重程度及预后情况.%Objective To analyze the clinical value of serum procalcitonin (PCT) and C-reactive protein (CRP) in acute cholangitis (AC).Methods The clinical data of 76 patients with AC in the Third Ward of Hepatobiliary & Pancreatic Surgery,the Second Affiliated Hospital of Kunming Medical University from March 2016 to July 2017 were retrospectively analyzed.According to the severity of AC,76 patients were divided into the mild AC group (n =42) and moderate to severe AC group (n =34).In addition,69 patients with cholangiolithiasis but no infection in the same period were selected as the control group.The changes in PCT and CRP levels before and after treatment and the sensitivity and specificity of PCT and CRP detection in the diagnosis of AC between two groups were compared.Receive operating characteristic curve (ROC curve) was used to compare the ability of PCT and CRP in early diagnosis and severity evaluation of AC.Results The PCT and CRP levels in the AC group before treatment were higher than those in the control group with statistically significant difference (P＜0.001).The PCT and CRP levels in the mild AC group were lower than those in the moderate to severe AC group with statistically significant difference (P＜0.001).The serum PCT and CRP levels in the AC group after treatment were significantly lower than those before treatment (P＜0.001),and the sensitivity and specificity of PCT were better than those of CRP with statistically significant difference (P＜0.001).ROC curve revealed that the area under curve (AUC) of PCT was 0.81(95％ CI:0.86-0.94),which was significantly higher than CRP (0.64;95％ CI:0.63-0.77).Conclusions The PCT and CRP can be detected early for AC.And the clinical value of PCT for the early diagnosis of AC is better than that of CRP,with high sensitivity and specificity,which can help clinicians to evaluate the severity and prognosis of AC.