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[1]赵色玲,王凡,许春,等.血清降钙素原与C反应蛋白及内毒素在经皮肾镜取石术后尿脓毒症早期诊断中的价值[J].医学研究与战创伤救治(原医学研究生学报),2018,20(02):130-133.[doi:10.3969/j.issn.1672-271X.2018.02.005]
　ZHAO Se-ling,WANG Fan,XU Chun,et al.The significance of procalcitonin, C reactive protein and lipopolysaccharide in the early diagnosis of urinary sepsis after percutaneous nephrolithotomy[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2018,20(02):130-133.[doi:10.3969/j.issn.1672-271X.2018.02.005]
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血清降钙素原与C反应蛋白及内毒素在经皮肾镜取石术后尿脓毒症早期诊断中的价值()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第20卷
期数:
2018年02期
页码:
130-133
栏目:
出版日期:
2018-03-20

文章信息/Info

Title:
The significance of procalcitonin, C reactive protein and lipopolysaccharide in the early diagnosis of urinary sepsis after percutaneous nephrolithotomy
作者:
赵色玲; 王凡; 许春; 刘焜; 陈世伟
作者单位：361003厦门，解放军第一七四医院泌尿外科（赵色玲、王凡、许春、刘焜、陈世伟）
Author(s):
ZHAO Se-ling; WANG Fan; XU Chun;  LIU Kun; CHEN Shi-wei
（Department of Urology, the 174th Hospital of PLA, Xiamen 361003,Fujian, China）
关键词:
降钙素原; 内毒素; C-反应蛋白; 经皮肾镜取石术; 尿源性脓毒症
Keywords:
procalcitonin;  lipopolysaccharide;  C-reactive protein;  percutaneous nephrolithotomy;  urinary sepsis
分类号:
R604
DOI:
10.3969/j.issn.1672-271X.2018.02.005
文献标志码:
A
摘要:
目的 评估降钙素原（PCT）、C反应蛋白（CRP）与内毒素作为特异性标记物，在经皮肾镜取石术（PCNL）术后尿脓毒症早期诊断中的价值，评价三者在脓毒症严重程度、病原菌鉴别及治疗疗效判定上的价值。方法 回顾性分析解放军第一七四医院于2013年1月至2017年6月因上尿路结石行PCNL的468例患者临床资料，其中术后发生尿脓毒症43例（脓毒症组）、严重尿脓毒症11例（严重脓毒症组）、脓毒性休克2例（因样本量过小未纳入分析）。同期38例仅单纯发热、无脓毒症的患者作为对照组。检测PCNL术前及术后患者血清PCT、CRP及内毒素值，绘制受试者工作曲线（ROC），分析三者的诊断价值；检测治疗前后3组患者的PCT及内毒素值。结果 治疗前严重脓毒症组PCT及内毒素检测值均高于脓毒症组[（25.90±5.01）ng/mL vs （2.55±1.23）ng/mL，（1.31±0.35）EU/mL vs （0.80±0.47）EU/mL]，脓毒症组和严重脓毒症组两检测值均高于对照组[PCT（0.44±0.48）ng/mL，内毒素（0.27±0.20）EU/mL，P＜0.01]。治疗后脓毒症组及严重脓毒症组PCT检测值均低于治疗前（P＜0.01）。脓毒症组及严重脓毒症组治疗前后内毒素水平对比差异无统计学意义（P＞0.05）。PCT诊断尿脓毒症曲线下面积（AUC）为 0.985，特异度为97.7%，灵敏度为92.1%，CRP的AUC为0.869，特异度为71.1%，灵敏度为95.3%，内毒素的AUC为0.824，特异度为76.7%，灵敏度为60.5%。结论 PCT、CRP、内毒素在PCNL术后尿脓毒症的判定上具有一定临床实用价值，PCT的特异性及准确性明显优于CRP及内毒素，可以作为一种评价治疗效果及疾病严重程度的指标。三者检测值结合后进行综合分析判断，可更好地对PCNL术后尿脓毒症进行评估。
Abstract:
Objective To evaluate the value of procalcitonin (PCT), C reactive protein (CRP) and lipopolysaccharide (LPS) as a specific marker in the diagnosis of early sepsis after percutaneous nephrolithotomy (PCNL), and to evaluate the significance of the three indicators in the severity of sepsis, the identification of pathogenic bacteria and the judgement of therapeutic efficacy in order to provide reference for the clinical diagnosis and treatment of sepsis after PCNL.Methods 43 cases of urinary sepsis patients(the sepsis group), 11 cases of severe urinary sepsis(the severe sepsis group ), 2 cases of septic shock(septic shock was excluded) and 38 cases of fever alone(the control group) were selected from 468 cases of renal calculus treated with PCNL from Jan. 2013 to Jun. 2017. The levels of serum PCT, CRP and LPS in patients before and after PCNL and the level of PCT and LPS before and after the treatment were measured and analyzed. The performance curve (ROC curve) of the three groups was also taken into analyzation.Results The values of PCT and LPS in the severe sepsis group were higher than those in the sepsis group[（25.90±5.01）ng/mL vs （2.55±1.23）ng/mL，（1.31±0.35）EU/mL vs （0.80±0.47）EU/mL] before treatment, the severe sepsis group and the sepsis group was higher than the control group[PCT（0.44±0.48）ng/mL，LPS（0.27±0.20）EU/mL,P＜0.01]. The PCT values of sepsis group and severe sepsis group after treatment were lower than those before treatment (P＜0.01). The LPS values of sepsis group and severe sepsis group before and after treatment were not statistically significant. The Area Under ROC Curve (AUC) of PCT was 0.985, the specificity was 97.7% and the sensitivity was 92.1%. The AUC of CRP was 0.869, the specificity was 71.1% and the sensitivity was 95.3%. The AUC of LPS was 0.824, the specificity was 76.7% and the sensitivity was 60.5%.Conclusion The PCT, CRP and LPS have certain clinical value in the diagnosis of urosepsis after PCNL. The accuracy of the PCT is significantly better than CRP and LPS. The PCT can be used as an indicator to evaluate the effect of treatment and the severity of urosepsis. In order to better evaluate, the three detection values can be combined and comprehensive analyzed.

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备注/Memo:
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更新日期/Last Update: 2018-03-20