尿脓毒血症的早期诊断及妊娠期尿脓毒血症早期诊治方法的临床研究
发布时间：2019-02-19 08:43
【摘要】：研究目的1.检测PCT、IL-6及CRP在尿脓毒血症患者血清中的表达水平,探讨PCT联合IL-6、CRP检测在尿脓毒血症早期诊断中的应用价值。2.探索妊娠期尿脓毒血症的早期快速诊断方法及临床合理有效的治疗方案,保障妊娠期妇女及胎儿的安全与健康。研究方法1.选取2014年9月~2016年12月因尿路感染在我院接受治疗的105例患者的临床资料,将其分为3组,其中急性膀胱炎组患者30例,男性14例,女性16例,年龄38—54岁;尿脓毒血症组患者55例,男性25例,女性30例,年龄49—68岁;尿脓毒血症并发休克组患者20例,男性11例,女性9例,年龄55—74岁。统计各组患者治疗前后血常规NEU百分比、尿常规WBC计数、PCT、IL-6及CRP表达水平的变化,绘制ROC曲线评价各个炎症指标及多指标联合检测在尿脓毒血症早期诊疗应用中的价值。2.分析2010年1月至2016年12月于我泌尿外科中心接受治疗的32例妊娠期尿脓毒症患者的临床资料,年龄23—31岁,孕周21—30周;选取32例同期入院的妊娠期急性膀胱炎患者为对照组,年龄22—32岁,孕周20—29周,比较两组患者治疗前后的血常规中性粒细胞百分比、尿常规白细胞计数以及PCT、IL-6及CRP表达水平的变化,评价各个炎症指标在妊娠期尿脓毒血症早期诊断应用中的价值,总结妊娠期尿脓毒血症的有效治疗方法。研究结果1.血清PCT、IL-6和CRP的表达水平在尿脓毒血症组、尿脓毒血症并发休克组与急性膀胱炎组相比均有统计学差异(P0.05);PCT与其他指标相比,单指标的诊断价值最大;PCT联合IL-6、CRP检测优于单一指标检测的诊断价值。2.妊娠期尿脓毒血症组与急性膀胱炎组相比,血清PCT、IL-6及CRP的表达水平均有统计学差异(P0.05),三种炎症指标联合应用优于血常规NEU百分比及尿常规WBC计数的诊断价值。双J置入术后3天及7天分别与治疗前相比血常规NEU百分比、尿常规WBC计数、PCT、IL-6及CRP的数值均下降,各个炎症指标数值下降的幅度均有统计学差异(p0.05)。结论1.PCT、IL-6及CRP在尿脓毒血症诊断方面优于血常规NEU百分比及尿常规WBC计数,单一PCT应用有较高的诊断价值。PCT、IL-6及CRP联合检测有助于尿脓毒血症的早期诊断,对评价尿路感染的严重程度有一定的临床意义。2.PCT及IL-6、CRP检测有助于妊娠期尿脓毒血症的早期诊断,对评价感染的严重程度及疗效有一定的临床指导意义。中晚期妊娠期尿脓毒血症的患者,适时的腔道手术治疗及双J管置入术,可解除梗阻,利于感染控制。
[Abstract]:Objective 1. To detect the expression of PCT,IL-6 and CRP in serum of patients with urinary sepsis and to explore the value of PCT combined with IL-6,CRP in the early diagnosis of urinary sepsis. 2. To explore the early rapid diagnosis and clinical effective treatment of urinary sepsis in pregnancy to ensure the safety and health of pregnant women and fetuses. Method 1. The clinical data of 105 patients treated with urinary tract infection from September 2014 to December 2016 were divided into three groups: 30 patients with acute cystitis, 14 males and 16 females aged 38-54 years. There were 55 patients with urosepsis, 25 males and 30 females aged 49-68 years, and 20 patients with sepsis complicated with shock, 11 males and 9 females aged 55-74 years. The changes of blood routine NEU percentage, urine routine WBC count, PCT,IL-6 and CRP expression were analyzed before and after treatment. To evaluate the value of ROC curve in the early diagnosis and treatment of urinary sepsis. To analyze the clinical data of 32 cases of gestational urinary sepsis treated in our urology center from January 2010 to December 2016, aged 23-31 years, 21-30 weeks of gestational age; Thirty-two patients with acute cystitis complicating pregnancy, aged 22-32 years and 20-29 weeks of gestation, were selected as control group. The percentage of neutrophils, urine leukocyte count and PCT, before and after treatment were compared between the two groups. The changes of IL-6 and CRP expression, the value of various inflammatory indexes in early diagnosis of urinary sepsis during pregnancy was evaluated, and the effective treatment of urinary sepsis during pregnancy was summarized. Results 1. The levels of serum PCT,IL-6 and CRP were significantly higher in sepsis group, sepsis complicated shock group and acute cystitis group (P0.05); PCT compared with other indexes, the diagnostic value of single index was the greatest; The diagnostic value of PCT combined with IL-6,CRP is better than that of single index detection. 2. Compared with acute cystitis group, the expression of serum PCT,IL-6 and CRP in pregnant women with urinary sepsis were significantly different (P0.05). The combined use of the three inflammatory markers was superior to the diagnostic value of routine blood NEU percentage and urine routine WBC count. The percentage of blood routine NEU, urine routine WBC count, PCT,IL-6 and CRP were decreased 3 and 7 days after double J implantation, respectively. There was significant difference in the extent of the decrease of each inflammatory index (p0.05). Conclusion\ The detection of 2.PCT and IL-6,CRP is helpful to the early diagnosis of urinary sepsis in pregnancy and has a certain clinical significance in evaluating the severity and curative effect of infection. The patients with urinary sepsis in late pregnancy can be relieved of obstruction and infection control by timely surgical treatment of cavities and double J tube implantation.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.258
本文编号：2426323
[Abstract]:Objective 1. To detect the expression of PCT,IL-6 and CRP in serum of patients with urinary sepsis and to explore the value of PCT combined with IL-6,CRP in the early diagnosis of urinary sepsis. 2. To explore the early rapid diagnosis and clinical effective treatment of urinary sepsis in pregnancy to ensure the safety and health of pregnant women and fetuses. Method 1. The clinical data of 105 patients treated with urinary tract infection from September 2014 to December 2016 were divided into three groups: 30 patients with acute cystitis, 14 males and 16 females aged 38-54 years. There were 55 patients with urosepsis, 25 males and 30 females aged 49-68 years, and 20 patients with sepsis complicated with shock, 11 males and 9 females aged 55-74 years. The changes of blood routine NEU percentage, urine routine WBC count, PCT,IL-6 and CRP expression were analyzed before and after treatment. To evaluate the value of ROC curve in the early diagnosis and treatment of urinary sepsis. To analyze the clinical data of 32 cases of gestational urinary sepsis treated in our urology center from January 2010 to December 2016, aged 23-31 years, 21-30 weeks of gestational age; Thirty-two patients with acute cystitis complicating pregnancy, aged 22-32 years and 20-29 weeks of gestation, were selected as control group. The percentage of neutrophils, urine leukocyte count and PCT, before and after treatment were compared between the two groups. The changes of IL-6 and CRP expression, the value of various inflammatory indexes in early diagnosis of urinary sepsis during pregnancy was evaluated, and the effective treatment of urinary sepsis during pregnancy was summarized. Results 1. The levels of serum PCT,IL-6 and CRP were significantly higher in sepsis group, sepsis complicated shock group and acute cystitis group (P0.05); PCT compared with other indexes, the diagnostic value of single index was the greatest; The diagnostic value of PCT combined with IL-6,CRP is better than that of single index detection. 2. Compared with acute cystitis group, the expression of serum PCT,IL-6 and CRP in pregnant women with urinary sepsis were significantly different (P0.05). The combined use of the three inflammatory markers was superior to the diagnostic value of routine blood NEU percentage and urine routine WBC count. The percentage of blood routine NEU, urine routine WBC count, PCT,IL-6 and CRP were decreased 3 and 7 days after double J implantation, respectively. There was significant difference in the extent of the decrease of each inflammatory index (p0.05). Conclusion\ The detection of 2.PCT and IL-6,CRP is helpful to the early diagnosis of urinary sepsis in pregnancy and has a certain clinical significance in evaluating the severity and curative effect of infection. The patients with urinary sepsis in late pregnancy can be relieved of obstruction and infection control by timely surgical treatment of cavities and double J tube implantation.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.258
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