動(dòng)態(tài)監(jiān)測血清降鈣素原在繼發(fā)性腹膜炎中的臨床應(yīng)用研究
發(fā)布時(shí)間：2018-07-22 12:09
【摘要】：[目的]由于目前降鈣素原在臨床特異性疾病中的應(yīng)用越加重要,故本研究的目的主要是:第一、驗(yàn)證PCT的連續(xù)性監(jiān)測在外科中,對(duì)縮短繼發(fā)性腹膜炎患者的抗生素應(yīng)用時(shí)間及住院時(shí)間等方面具有較高的臨床與經(jīng)濟(jì)價(jià)值;第二、探究不同腹腔積液類型的繼發(fā)性腹膜炎患者在PCT監(jiān)測水平及臨床抗感染治療方面是否存在差異,如存在,該種差異是否可為積液的診斷及鑒別診斷提供有效信息;第三、因繼發(fā)性腹膜炎病情復(fù)雜,傳統(tǒng)用來判定細(xì)菌感染情況的PCT(Procalcitonin,降鈣素原)交界值,即CUT OFF(被檢分析物的量值,用于確定結(jié)果高于還是低于臨床或分析決斷點(diǎn))可能發(fā)生變化,重新統(tǒng)計(jì)此類患者的CUT OFF值有利于對(duì)其感染情況進(jìn)行更準(zhǔn)確的把握;第四、結(jié)合其他常見感染性炎癥標(biāo)志物探討提高細(xì)菌感染診斷效能的方式。[方法]該研究以昆明醫(yī)科大學(xué)第六附屬醫(yī)院為研究單位,選擇普外一科和普外二科2013年1月至2016年7月,單純胃液性、腸內(nèi)容物性及血液性腹腔積液型繼發(fā)性腹膜炎手術(shù)患者。第一、將非感染組中PCT監(jiān)測組與非監(jiān)測組的住院時(shí)間、抗生素費(fèi)用、住院費(fèi)用進(jìn)行統(tǒng)計(jì)分析;第二、將不同腹腔積液類型腹膜炎患者入院急查、手術(shù)當(dāng)天、術(shù)后第一天及第二天PCT的監(jiān)測結(jié)果平均值進(jìn)行統(tǒng)計(jì)分析并制成趨勢圖,觀察三種不同繼發(fā)性腹膜炎類型對(duì)PCT水平的影響差異;再將該組研究對(duì)象的住院時(shí)間、抗生素費(fèi)用和拔管時(shí)間分別進(jìn)行統(tǒng)計(jì)分析,了解上述因素之間的相關(guān)性;第三、為指出該項(xiàng)指標(biāo)在輔助判斷細(xì)菌感染方面具有較高的靈敏度,繪制自手術(shù)之日起連續(xù)六天監(jiān)測PCT水平變化趨勢圖,觀察兩組PCT平均值在排除致病因素后的變化情況,分析二者在時(shí)間節(jié)點(diǎn)上的差異;第四、為統(tǒng)計(jì)PCT在診斷不同類型繼發(fā)性腹膜炎時(shí)的CUT OFF值及效能,利用研究對(duì)象入院當(dāng)天急查的PCT值繪制受試者單獨(dú)檢測PCT時(shí)的工作特征曲線(receiver operating characteristic curve,簡稱 ROC 曲線);利用入院當(dāng)天急查PCT、白介素-6(Interleukin 6,IL-6)、C-反應(yīng)蛋白(C-reactive protein,CRP)和白細(xì)胞(leukocyte,WBC)值,探究上述四項(xiàng)指標(biāo)在聯(lián)合應(yīng)用時(shí)是否可進(jìn)一步提升對(duì)細(xì)菌感染的診斷效能。[結(jié)果]第一、對(duì)PCT連續(xù)監(jiān)測的必要性與PCT在不同類型腹膜炎中的變化情況進(jìn)行分析的統(tǒng)計(jì)結(jié)果可見,PCT連續(xù)性監(jiān)測情況良好組的住院時(shí)間、抗生素療程、抗生素費(fèi)用和住院費(fèi)用均明顯低于對(duì)照組;第二、在非感染性炎癥監(jiān)測方面,血液性腹膜炎患者入院急查PCT水平較低(0.5ng/mL),且變化幅度最小,腸內(nèi)容物性及胃液性腹膜炎患者PCT水平變化趨勢較為相似,遠(yuǎn)高于血液性腹膜炎患者,而胃液性腹膜炎患者的PCT水平又高于腸內(nèi)容物性腹膜炎患者,于手術(shù)當(dāng)天達(dá)到峰值,術(shù)后胃液性及腸內(nèi)容物性腹膜炎患者的PCT變化呈同步快速回落趨勢。再根據(jù)血液性、腸內(nèi)容物性和胃內(nèi)容物性腹膜炎患者住院時(shí)間、抗生素費(fèi)用和拔管時(shí)間的比較可見,血液性腹膜炎患者住院時(shí)間和抗生素費(fèi)用明顯低于腸內(nèi)容物性和胃液性患者;第三、從PCT對(duì)細(xì)菌感染的診斷效能評(píng)估角度分析,自手術(shù)當(dāng)天到第二天,感染組與非感染組的PCT平均值之間的差距達(dá)到最大;第四、將PCT診斷繼發(fā)性腹膜炎細(xì)菌感染的CUT OFF值重新確定為1ng/mL;將PCT、IL-6、CRP及WBC四項(xiàng)感染性標(biāo)記物分別作為輔助判斷感染的監(jiān)測項(xiàng)目時(shí),診斷感染時(shí)的靈敏度大小為:PCTIL-6CRPWWBC,在診斷繼發(fā)性腹膜炎的細(xì)菌感染時(shí)準(zhǔn)確度最高的為PCT,再將四個(gè)指標(biāo)進(jìn)行多項(xiàng)聯(lián)合診斷分析,得出ROC曲線下面積為0.981,進(jìn)一步提高了對(duì)細(xì)菌感染的診斷效能。[結(jié)論]1、PCT的動(dòng)態(tài)監(jiān)測可適當(dāng)控制患者的抗生素使用。2、PCT的動(dòng)態(tài)監(jiān)測水平可為繼發(fā)性腹膜炎不同類型積液的診斷及鑒別診斷提供一定的參考依據(jù)。3、本次研究結(jié)果得出,在繼發(fā)性腹膜炎患者中PCT指導(dǎo)抗生素應(yīng)用的CUT OFF值為 1ng/mL。4、在繼發(fā)性腹膜炎中,PCT對(duì)細(xì)菌感染的診斷效能高于其他傳統(tǒng)感染性炎癥標(biāo)志物;如聯(lián)合IL-6、CRP及WBC等傳統(tǒng)炎癥標(biāo)志物,診斷效能將進(jìn)一步提升。
[Abstract]:[Objective] because the application of calcitonin in the clinical specific diseases is more and more important, the purpose of this study is mainly: first, to verify the continuous monitoring of PCT in surgery, to shorten the time of the application of antibiotics and the time of hospitalization for the patients with secondary peritonitis, and second, to explore the different abdomen. Whether there are differences in PCT monitoring level and clinical anti infection treatment in patients with secondary peritonitis of the type of cavity effusion, for example, whether this difference can provide effective information for the diagnosis and differential diagnosis of effusion; third, PCT (Procalcitonin, calcitonin), which is traditionally used to determine the condition of bacterial infection because of the complication of secondary peritonitis The boundary value, that is, CUT OFF (the value of the detected analyte, is used to determine whether the result is higher or below the clinical or analysis decision point) may change. The re statistics of the CUT OFF value of such patients is beneficial to the more accurate grasp of the infection situation; fourth, to improve the diagnosis of bacterial infection in combination with other common infectious inflammatory markers. Method of effectiveness. [Methods] the study took the Sixth Affiliated Hospital of Kunming Medical University as the research unit, and selected the patients with simple gastric juice, intestinal content and hematologic secondary peritonitis from January 2013 to July 2016 of the first and two families of the Kunming Medical University. First, the non infection group and the non monitoring group were hospitalized. Time, cost of antibiotics and hospitalization expenses were statistically analyzed. Second, the patients with peritonitis with different peritoneal effusion were admitted to hospital, the day of operation, the average value of PCT monitoring results on the first day and the first two days after operation were statistically analyzed and the trend map was made to observe the difference of the effect of three types of successive peritonitis to the level of PCT. The time of hospitalization, the cost of antibiotics and the time of extubation were statistically analyzed to understand the correlation between the above factors. Third, it was pointed out that the index had a high sensitivity in auxiliary judgment of bacterial infection, and the trend map of monitoring PCT level for six consecutive days from the day of operation was drawn, and the average of the two groups of PCT was observed. The difference in the time node was analyzed after the elimination of the pathogenic factors, and the difference between the two in time nodes was analyzed. Fourth, the value and efficacy of PCT in the diagnosis of different types of secondary peritonitis of different types were calculated, and the PCT value of PCT was plotted by the PCT values of the subjects who were examined on the day of admission (receiver operating characteristi). C curve, referred to as the ROC curve); to explore whether the above four indicators can further improve the diagnostic efficiency of the bacterial infection when combined application of PCT, -6 (Interleukin 6, IL-6), C- reactive protein (C-reactive protein, CRP) and leukocyte (leukocyte)) on the day of admission. [results] first, the necessity of continuous monitoring The analysis of the changes in different types of peritonitis with PCT showed that the time of hospitalization of the group with good PCT continuity monitoring, antibiotic treatment course, antibiotic cost and hospitalization cost were significantly lower than those of the control group; second, the level of PCT in the patients with hematologic peritonitis in the non infectious inflammation monitoring was lower (0.5N G/mL), with the smallest change range, the change trend of PCT level in intestinal contents and gastric juice peritonitis was similar, far higher than that of patients with hematological peritonitis, and the PCT level of patients with gastric juice peritonitis was higher than that of intestinal material peritonitis. The peak value of the operation day, the postoperative gastric juice and the PCT of the patients with intestinal contents peritonitis were higher than those of the patients with gastric juice peritonitis. The change showed a synchronous and rapid decline trend. According to the blood sex, intestinal content physical properties and gastric content physical peritonitis patients' hospitalization time, antibiotic cost and extubation time, the hospitalization time and antibiotic cost of patients with hematologic peritonitis were significantly lower than those of intestinal content and gastric juice; third, the diagnosis of bacterial infection from PCT The difference between the PCT average of the infection group and the non infected group reached the maximum from the day of the operation to second days. Fourth, the CUT OFF value of the PCT diagnosis of secondary peritonitis infection was redefined as 1ng/mL, and four infectious markers of PCT, IL-6, CRP and WBC were used as the auxiliary monitoring items for the detection of infection, The sensitivity of the diagnosis of infection was: PCTIL-6CRPWWBC, the highest degree of accuracy was PCT in the diagnosis of secondary peritonitis, and four indexes were combined with multiple diagnostic analyses. The area under the ROC curve was 0.981, which further improved the diagnostic efficacy of bacterial infection. [conclusion]1, dynamic monitoring of PCT can properly control the patient. The use of.2, the dynamic monitoring level of PCT can provide a reference for the diagnosis and differential diagnosis of different types of secondary peritonitis. The results of this study showed that the CUT OFF value of the application of PCT in secondary peritonitis was 1ng/mL.4, and in secondary peritonitis, the diagnosis of PCT for bacterial infection was found in secondary peritonitis. The diagnostic efficacy is higher than other traditional inflammatory markers. If combined with IL-6, CRP, WBC and other traditional inflammatory markers, the diagnostic efficiency will be further improved.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R572.2
本文編號(hào)：2137419
[Abstract]:[Objective] because the application of calcitonin in the clinical specific diseases is more and more important, the purpose of this study is mainly: first, to verify the continuous monitoring of PCT in surgery, to shorten the time of the application of antibiotics and the time of hospitalization for the patients with secondary peritonitis, and second, to explore the different abdomen. Whether there are differences in PCT monitoring level and clinical anti infection treatment in patients with secondary peritonitis of the type of cavity effusion, for example, whether this difference can provide effective information for the diagnosis and differential diagnosis of effusion; third, PCT (Procalcitonin, calcitonin), which is traditionally used to determine the condition of bacterial infection because of the complication of secondary peritonitis The boundary value, that is, CUT OFF (the value of the detected analyte, is used to determine whether the result is higher or below the clinical or analysis decision point) may change. The re statistics of the CUT OFF value of such patients is beneficial to the more accurate grasp of the infection situation; fourth, to improve the diagnosis of bacterial infection in combination with other common infectious inflammatory markers. Method of effectiveness. [Methods] the study took the Sixth Affiliated Hospital of Kunming Medical University as the research unit, and selected the patients with simple gastric juice, intestinal content and hematologic secondary peritonitis from January 2013 to July 2016 of the first and two families of the Kunming Medical University. First, the non infection group and the non monitoring group were hospitalized. Time, cost of antibiotics and hospitalization expenses were statistically analyzed. Second, the patients with peritonitis with different peritoneal effusion were admitted to hospital, the day of operation, the average value of PCT monitoring results on the first day and the first two days after operation were statistically analyzed and the trend map was made to observe the difference of the effect of three types of successive peritonitis to the level of PCT. The time of hospitalization, the cost of antibiotics and the time of extubation were statistically analyzed to understand the correlation between the above factors. Third, it was pointed out that the index had a high sensitivity in auxiliary judgment of bacterial infection, and the trend map of monitoring PCT level for six consecutive days from the day of operation was drawn, and the average of the two groups of PCT was observed. The difference in the time node was analyzed after the elimination of the pathogenic factors, and the difference between the two in time nodes was analyzed. Fourth, the value and efficacy of PCT in the diagnosis of different types of secondary peritonitis of different types were calculated, and the PCT value of PCT was plotted by the PCT values of the subjects who were examined on the day of admission (receiver operating characteristi). C curve, referred to as the ROC curve); to explore whether the above four indicators can further improve the diagnostic efficiency of the bacterial infection when combined application of PCT, -6 (Interleukin 6, IL-6), C- reactive protein (C-reactive protein, CRP) and leukocyte (leukocyte)) on the day of admission. [results] first, the necessity of continuous monitoring The analysis of the changes in different types of peritonitis with PCT showed that the time of hospitalization of the group with good PCT continuity monitoring, antibiotic treatment course, antibiotic cost and hospitalization cost were significantly lower than those of the control group; second, the level of PCT in the patients with hematologic peritonitis in the non infectious inflammation monitoring was lower (0.5N G/mL), with the smallest change range, the change trend of PCT level in intestinal contents and gastric juice peritonitis was similar, far higher than that of patients with hematological peritonitis, and the PCT level of patients with gastric juice peritonitis was higher than that of intestinal material peritonitis. The peak value of the operation day, the postoperative gastric juice and the PCT of the patients with intestinal contents peritonitis were higher than those of the patients with gastric juice peritonitis. The change showed a synchronous and rapid decline trend. According to the blood sex, intestinal content physical properties and gastric content physical peritonitis patients' hospitalization time, antibiotic cost and extubation time, the hospitalization time and antibiotic cost of patients with hematologic peritonitis were significantly lower than those of intestinal content and gastric juice; third, the diagnosis of bacterial infection from PCT The difference between the PCT average of the infection group and the non infected group reached the maximum from the day of the operation to second days. Fourth, the CUT OFF value of the PCT diagnosis of secondary peritonitis infection was redefined as 1ng/mL, and four infectious markers of PCT, IL-6, CRP and WBC were used as the auxiliary monitoring items for the detection of infection, The sensitivity of the diagnosis of infection was: PCTIL-6CRPWWBC, the highest degree of accuracy was PCT in the diagnosis of secondary peritonitis, and four indexes were combined with multiple diagnostic analyses. The area under the ROC curve was 0.981, which further improved the diagnostic efficacy of bacterial infection. [conclusion]1, dynamic monitoring of PCT can properly control the patient. The use of.2, the dynamic monitoring level of PCT can provide a reference for the diagnosis and differential diagnosis of different types of secondary peritonitis. The results of this study showed that the CUT OFF value of the application of PCT in secondary peritonitis was 1ng/mL.4, and in secondary peritonitis, the diagnosis of PCT for bacterial infection was found in secondary peritonitis. The diagnostic efficacy is higher than other traditional inflammatory markers. If combined with IL-6, CRP, WBC and other traditional inflammatory markers, the diagnostic efficiency will be further improved.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R572.2
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