血浆降钙素原对于早期诊断继发于经皮肾镜碎石术的尿脓毒血症的临床意义

发布时间：2018-06-21 20:40

本文选题：经皮肾镜碎石术 + 尿脓毒血症　；参考：《青岛大学》2014年硕士论文

【摘要】：目的：探讨通过监测血浆降钙素原(procalcitonin, PCT)水平对于早期诊断继发于经皮肾镜碎石术(percutaneous nephrolithotomy, PCNL)的尿脓毒血症的临床意义。方法：回顾性分析青岛大学附属医院泌尿外科住院部2012年1月至2013年11月收治的复杂上尿路结石并行PCNL手术患者共98例,按照2013年欧洲泌尿外科学会指南(EAU Guidelines)对尿脓毒血症的诊断标准分为观察组(PCNL术后继发尿脓毒血症)48例和对照组(PCNL术后未出现尿脓毒血症)50例,回顾性分析两组患者术前、术后6h内、术后24h所检测的血浆PCT和C-反应蛋白(c-reactive protein, CRP)水平,计算两组数据均数、标准差,组内数据统计分析采用配对t检验,P0.05为差异具有统计学意义；组间数据统计分析采用成组t检验,P0.05为差异具有统计学意义；评价PCT和CRP对尿脓毒血症的诊断效能采用受试者工作特征曲线(ROC曲线),计算ROC曲线下面积(AUC),对AUC比较采用Z检验,P0.05为差异具有统计学意义,并分析PCT和CRP对尿脓毒血症的诊断敏感度、特异度以及最佳截断点(临界值)。结果：两组患者术前PCT、CRP水平均在正常范围,组内、组间比较均无统计学意义(P0.05)；观察组48例患者均于术后6h内出现尿脓毒血症,对观察组和对照组患者的PCT、CRP水平进行组内比较,发现其均较术前升高(P0.05),进行组间比较,发现观察组PCT水平较对照组明显升高(P0.01),而观察组CRP亦较对照组升高(P0.05),但对两项诊断指标PCT和CRP的诊断效能进行ROC曲线分析,结果显示PCT的AUC较CRP的AUC大,差异比较具有统计学意义(P0.05)。结论：PCNL术后疑似继发尿脓毒血症时,测定血PCT水平有助于对尿脓毒血症的早期临床诊断,PCT对尿脓毒血症的诊断效能较CRP更高。
[Abstract]:Objective: to investigate the clinical significance of monitoring plasma procalcitonin (PCT) level in early diagnosis of urinary sepsis secondary to percutaneous nephrolithotripsy (PCNL). Methods: a retrospective analysis of 98 patients with complicated upper urinary calculi treated by PCNL from January 2012 to November 2013 was performed in the Department of Urology, affiliated Hospital of Qingdao University. According to the guidelines of the European Society of Urology (2013), Eau Guidelines-based criteria for the diagnosis of urinary sepsis were divided into observation group (n = 48) and control group (n = 50). The levels of plasma PCT and C-reactive protein (CRP) were measured within 6 hours and 24 hours after operation. The mean and standard deviation of the two groups were calculated. The statistical analysis of the data in the group was statistically significant by pairing t test (P0.05). There was statistical significance in statistical analysis of data between groups by using group t test (P0.05). To evaluate the effectiveness of PCT and CRP in the diagnosis of urinary sepsis the ROC curve was used to calculate the area under the ROC curve and the area under the ROC curve was calculated. There was significant difference in AUC using Z test (P0.05). The sensitivity, specificity and optimal cut-off point of PCT and CRP in the diagnosis of urinary sepsis were analyzed. Results: the preoperative levels of PCTnCRP in both groups were in the normal range, and there was no significant difference between the two groups, while in the observation group, the urinary sepsis was found in 48 patients within 6 hours after operation, and the levels of PCTnc-CRP in the observation group and the control group were compared. It was found that the level of PCT in the observation group was significantly higher than that in the control group, and the CRP in the observation group was also higher than that in the control group. However, the diagnostic efficacy of two diagnostic indexes, PCT and CRP, was analyzed by ROC curve analysis. The results showed that the AUC of PCT was larger than that of CRP, and the difference was statistically significant (P 0.05). Conclusion determination of blood PCT level is helpful to the early clinical diagnosis of urinary sepsis in patients with suspected secondary sepsis after urine PCNL. PCT is more effective than CRP in the diagnosis of urinary sepsis.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2

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