血清降钙素原联合C反应蛋白监测在输尿管镜碎石术后的临床意义

发布时间：2016-11-11 07:53

【摘要】 目的 探讨输尿管镜碎石术后并发感染及非感染患者的血清降钙素原（PCT）、C反应蛋白的变化及其临床意义。方法 回顾性分析我院泌尿外科2011年7月至2013年9月收治的400例输尿管结石行输尿管镜碎石术患者的临床资料，术后即对患者进行PCT、CRP、监测，根据PCT、CRP阳性判定的感染患者与最后确诊情况结果（体温升高（≧37.5℃）、WBC（>10×109g/L）结合细菌培养确诊）进行比较；并根据确诊结果将患者分为感染组（63例）、非感染组（337例）比较两组患者的PCT、CRP等指标情况。结果 临床和实验室最后确诊术后感染患者63例，PCT早期判定感染患者82例，诊断的灵敏度=82.54%，特异度=91.10%，漏诊率=17.46%，误诊率=8.9%。CRP早期判定感染患者181例，诊断的灵敏度60.32%，特异度=57.57%，漏诊率=39.68%，误诊率=42.43%；PCT的AUC值=0.901，CRP的AUC值=0.711；PCT与WBC呈显著的正相关（r=0.431，p=0.000<0.05）；CRP与WBC也呈显著的正相关（r=0.317，p=0.005）。结论 输尿管镜碎石术后患者并发感染与PCT、CRP具有一定的相关性，PCT、CRP可以作为术后并发感染早期的一种判断指标。
【关键词】输尿管镜；碎石术；并发感染；血清降钙素原；C反应蛋白

Clinic significance of serum procalcitonin and C reactive proteinmonitoring in after ureteroscopic lithotripsy
【Abstract】Objective Ureteroscopic lithotripsy for serum concurrent infection and non infectionpatients procalcitonin (PCT), C reactive protein and its clinical significance.Methods Retrospective analysis of our hospital from 2011 July to 2013 Septemberin Department of urology were treated 400 cases of ureteral calculiureteroscopic lithotripsy in patients with clinical data, postoperative PCT,CRP of patients, monitoring, according to the infection in patients with the final diagnosis result of PCT, CRP positive judgment (elevated body temperature (≥ 37.5 ℃), WBC (>10 * 109g/L) combined with bacterialculture confirmed) were compared; and the patients were divided intoinfection group according to the diagnosis (63 cases), non infection group(337 cases) were compared between the two groups PCT, CRP and other indicators.Results In 63 patients with final diagnosis of postoperative infection of clinical and laboratory, PCT early diagnosis of infection in patients with 82 cases, the sensitivity of =82.54% diagnosis, specificity of =91.10% =17.46%, the rate of missed diagnosis, misdiagnosis rate was =8.9%. Early diagnosis of 181 patients with CRP infection, 60.32% diagnosis sensitivity, specificity of =57.57% =39.68%, the rate of missed diagnosis, misdiagnosis rate=42.43%; PCT AUC =0.901, CRP AUC =0.711; positively correlated withPCT and WBC (r=0.431, p=0.000<0.05); CRP and WBC also had positive relationship (r=0.317, p=0.005).ConclusioAfter ureteroscopic lithotripsy in patients with concurrent infection with PCT, CRP has some relevance, PCT, CRP can be used as a judgment index of early postoperative infection after operation.
【Key words】Ureteroscopy; lithotripsy; infection; serum procalcitonin; C reactive protein

输尿管镜碎石术是治疗输尿管结石的重要手段，主要适用于输尿管中下段结石、结石周围被输尿管息肉包裹等情况，由于输尿管存在生理性狭窄，，而且管径比较细，采用输尿管镜进行碎石容易出现感染等多种并发症。及时准确的预测感染并给予合理的抗感染治疗，对于改善患者的预后具有重要作用。血清降钙素原（Procalcitonin,PCT)和急性期反应蛋白（Acute phase response proteins ,CRP)作为一个新的诊断细菌性感染的细胞因子指标，在感染性疾病的诊断中得到广泛重视，在本研究中检测了输尿管碎石术后感染患者和非感染患者的血清PCT和CRP水平，探讨二者在监测术后患者感染中的作用。

1、资料与方法
1.1一般资料
1.2方法
1.3 观测指标 
1.4统计方法
2结果
2.1PCT、CRP监测判定的感染结果与最后确诊的感染结果情况
2.2确诊的感染组和非感染组相关指标的比较
2.3术后感染患者的PCT、CRP与WBC的相关性分析
3 讨论
4 参考文献

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