降钙素原和C反应蛋白在急性胆源性胰腺炎中的诊断及预后价值比较

doi:10.16150/j.1671-2870.2019.06.012

摘要/Abstract

摘要：

目的：比较血清降钙素原（procalcitonin,PCT）和C反应蛋白（C-reactive protein,CRP）在急性胆源性胰腺炎（acute biliary pancretitis,ABP）早期诊疗中的应用价值。方法：回顾性地收集 2014年 1月至 2018年 3月上海交通大学医学院附属瑞金医院收治住院的 195例急性胰腺炎（acute pancretitis,AP）患者的相关资料,根据其病因分为ABP组和急性非胆源性胰腺炎组。其中,ABP组患者根据病情的严重程度进一步分为轻度ABP（mild acute biliary pacreatitis, MABP）、中重度ABP（moderately severe acute biliary pacreatitis, MSABP）和重度ABP（severe acute biliary pacreatitis, SABP）。比较各组间的入院48 h内血清PCT及CRP水平以及各组患者住院时的死亡率差异。结果：入院48 h内,ABP患者血清PCT水平高于急性非胆源性胰腺炎组[（11.1±5.11） μg/L比（3.86±1.64） μg/L]（P<0.05）,而2组间的CRP水平差异无统计学意义（P=0.342）;SABP患者的血清PCT水平明显高于MABP及MSABP患者。入院48 h内,未来发生院内死亡的ABP患者血清PCT水平明显升高,高于存活患者（P<0.001）,而这2组间的血清CRP水平差异无统计学意义（P=0.769）。结论：入院48 h内测得的血清PCT水平,对于AP患者病因的判断以及ABP严重度及预后的评估价值优于血清CRP。

关键词: 急性胰腺炎, 急性胆源性胰腺炎, 降钙素原, C反应蛋白

Abstract:

Objective: To compare the value of procalcitonin (PCT) and c-reactive protein (CRP) in early diagnosis and treatment of acute biliary pancreatitis. Methods: Data from a total of 195 patients diagnosed with acute pancreatitis (AP) from January 2014 to March 2018 in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. According to the etiology, the patients were divided into acute biliary pancreatitis (ABP) and acute non-biliary pancreatitis (ANBP) groups. And the ABP group was further divided into mild ABP (MABP), moderately severe ABP (MSABP) and severe ABP (SABP) groups according to the severity of the disease. Differences of PCT and CRP levels within 48 hours after admission and the in-hospital death rate were compared between these groups. Results: In the early 48 hours after admission the level of PCT in patients with ABP was higher than that of ANBP（P<0.05), while there was no difference in CPR between 2 groups. Serum procalcitonin level within 48 hours after admission in SABP group was significantly higher than those in MABP and MSABP groups. Procalcitonin level within 48 hours after admission was significantly higher in the dead group than in the surviving group (P<0.001), and CRP levels within 48 hours after admission had little differences among these groups（P=0.769）. Conclusions: In the early 48 hours after admission, the detection of serum PCT level is superior to CRP level for evaluating the severity and prognosis of ABP.

Key words: Acute pancreatitis, Acute biliary pancreatitis, Procalcitonin, C-reactive protein

中图分类号:

R675.51

张舒, 王露露, 孙璟, 江石湖. 降钙素原和C反应蛋白在急性胆源性胰腺炎中的诊断及预后价值比较[J]. 诊断学理论与实践, 2019, 18(06): 668-671.

ZHANG Shu, WANG Lulu, SUN Jing, JIANG Shihu. Value of procalcitonin and C-reactive protein in early stage acute biliary pancreatitis[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(06): 668-671.

图/表 3

参考文献 17

[1]	中华医学会消化病学分会胰腺疾病学组, 中华胰腺病杂志编辑委员会, 中华消化杂志编辑委员会.中国急性胰腺炎诊治指南(2013年,上海)[J]. 中华消化杂志, 2013, 33(4):217-222.
[2]	Bai Y, Liu Y, Jia L, et al. Severe acute pancreatitis in China: etiology and mortality in 1976 patients[J]. Pancreas, 2007, 35(3):232-237. doi: 10.1097/MPA.0b013e3180654d20 URL
[3]	Zhu Y, Pan X, Zeng H, et al. A Study on the etiology, severity, and mortality of 3260 patients with acute pancreatitis according to the Revised Atlanta Classification in Jiangxi, China over an 8-Year Period[J]. Pancreas, 2017, 46(4):504-509. doi: 10.1097/MPA.0000000000000776 URL
[4]	郑秉礼, 彭洁, 多鲁坤·买买提明. 新疆地区500例急性胰腺炎患者病因学及严重度的危险因素分析[J]. 实用临床医药杂志, 2017, 21(5):75-78,89.
[5]	Schuetz P, Maurer P, Punjabi V, et al. Procalcitonin decrease over 72 hours in US critical care units predicts fatal outcome in sepsis patients[J]. Crit Care, 2013, 17(3):R115. doi: 10.1186/cc12787 URL
[6]	Kalil AC, Metersky ML, Klompas M, et al. Executive summary: management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society[J]. Clin Infect Dis, 2016, 63(5):575-582. doi: 10.1093/cid/ciw504 URL
[7]	Dias BH, Rozario AP, Olakkengil SA, et al. Procalcitonin strip test as an independent predictor in acute pancreatitis[J]. Indian J Surg, 2015, 77(Suppl 3):1012-1017. doi: 10.1007/s12262-014-1112-8 URL
[8]	徐永红, 闫领, 边城, 等. 降钙素原在急性胰腺炎中的病情判断价值[J]. 世界华人消化杂志, 2015, 23(30):4898-4904.
[9]	Bejarano González N, Romaguera Monzonís A, García Borobia FJ,et al Influence of delayed cholecystectomy after acute gallstone pancreatitis on recurrence. Consequences of lack of resources[J]. Rev Esp Enferm Dig, 2016, 108(3):117-122. doi: 10.17235/reed.2016.4086/2015 pmid: 26864663
[10]	Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology guideline: management of acute panc-reatitis[J]. Am J Gastroenterol, 2013, 108(9):1400-1416. doi: 10.1038/ajg.2013.218 pmid: 23896955
[11]	高艳霞, 李莉, 李毅, 等. 降钙素原在急性胰腺炎病情判断中的意义[J]. 中国中西医结合急救杂志, 2014(3):201-204.
[12]	中国医药教育协会感染疾病专业委员会.感染相关生物标志物临床意义解读专家共识[J]. 中华结核和呼吸杂志, 2017, 40(4):243-257.
[13]	Bezmarevic M, Mirkovic D, Soldatovic I, et al. Correlation between procalcitonin and intra-abdominal pressure and their role in prediction of the severity of acute pancreatitis[J]. Pancreatology, 2012, 12(4):337-343. doi: 10.1016/j.pan.2012.05.007 pmid: 22898635
[14]	梁浩凡, 钟林滔, 程海兵, 等. 降钙素原检测在急性胰腺炎诊断及病情判断中的应用[C]. 北京: 2015临床急重症经验交流高峰论坛, 2015.
[15]	汤华, 桑卫东. 重症急性胰腺炎微创治疗研究进展[J]. 安徽医学, 2018, 39(3):367-369.
[16]	何文华, 陈鹏, 祝荫, 等. 基于新亚特兰大分类标准研究C反应蛋白和降钙素原在急性胰腺炎早期病情评估中的价值[J]. 中华消化杂志, 2016, 36(10):665-669.
[17]	高伟芳, 李晓, 桑荣霞, 等. 急性胆源性胰腺炎患者hs-CRP及PCT的表达及意义[J]. 现代生物医学进展, 2017, 17(19):3730-3733.

分组	例数（n）	PCT（μg/L）	CRP（mg/mL）
ABP组	72	11.1±5.11	156.12±102.07
急性非胆源性胰腺炎组	123	3.86±1.64	142.13±68.00
P值		0.017	0.342

分组	例数（n）	PCT（μg/L）	CRP（mg/mL）
MABP组	9	0.10±0.09^a)	90.75±75.23
MSABP组	24	1.86±0.35^a)	171.49±111.10
SABP组	39	19.80±6.87	163.56±102.07

分组	例数（n）	PCT（μg/L）	CRP（mg/mL）
ABP生存组	60	9.96±5.51	157.81±101.19
ABP死亡组	12	18.35±16.53	147.55±112.29
P值		<0.001	0.769