2017 年第 12 期 第 12 卷

降钙素原与白细胞计数及肿瘤坏死因子α和C反应蛋白对肠梗阻患者肠坏死早期诊断的临床价值

作者：赵克昌王皓吴世乐冯鹏才杨金煜

英文作者：

单位：810007西宁，青海省人民医院普外科（赵克昌、吴世乐、冯鹏才、杨金煜），重症医学科（王皓）

英文单位：

关键词：肠梗阻；降钙素原；白细胞计数；肿瘤坏死因子α；C反应蛋白；早期诊断

英文关键词：

• 摘要：

• 目的    探讨降钙素原、白细胞计数、肿瘤坏死因子α（TNF-α）及C反应蛋白（CRP）对于早期诊断肠梗阻患者出现肠坏死的意义。方法    回顾性分析2015年1月至2016年12月在青海省人民医院住院行手术治疗的348例肠梗阻患者的病历资料。按照术中是否发现有肠坏死情况分为2组：术中发现单纯肠粘连患者为粘连松解组（236例）；术中发现肠管坏死，行肠切除肠吻合的患者为肠切除组（112例）。收集所有患者入院时的降钙素原、白细胞计数、TNF-α以及CRP实验室检查资料。采用受试者工作特征（ROC）曲线分析各指标与肠梗阻患者发生肠坏死的关系。结果    肠切除组患者入院时降钙素原、白细胞计数、TNF-α及CRP水平均明显高于粘连松解组，差异均有统计学意义［（26±12）ng/L比（11±9）ng/L、（13±4）×109/L比（10±4）×109/L、（171±76）ng/L比（139±89）ng/L、（110±50）mg/L比（64±44）mg/L］（均P＜0.05）。经ROC曲线计算得出降钙素原、白细胞计数、TNF-α及CRP的曲线下面积依次为0.85、0.70、0.64、0.76，诊断肠坏死的敏感度依次为0.848、0.616、0.670、0.875，特异度依次为0.762、0.720、0.576、0.593，约登指数依次为14.46、11.91、132.20、5.66。结论    降钙素原在入院时早期诊断肠梗阻是否合并肠坏死方面，与白细胞计数、CRP及TNF-α相比具有更高的临床价值。

• Values of procalcitonin, white blood cell count, tumor necrosis factor-α and C-reactive protein in early diagnosis of bowel necrosis in patients with intestinal obstruction

  Zhao Kechang, Wang Hao, Wu Shile, Feng Pengcai, Yang Jinyu

  Department of General Surgery, Qinghai Provincial People′s Hospital, Xining  810007, China（Zhao KC, Wu SL, Feng PC, Yang JY）; Intensive Care Unit, Qinghai Provincial People′s Hospital, Xining 810007, China（Wang H）

  Corresponding author: Yang Jinyu, Email: qhyjy333@163.com

  【Abstract】Objective    To investigate the values of procalcitonin（PCT）, white blood cell count（WBC）, tumor necrosis factor-α（TNF-α） and C-reactive protein（CRP） in early diagnosis of bowel necrosis in patients with intestinal obstruction. Methods    Totally 348 patients who had surgery for intestinal obstruction were retrospectively analyzed from January 2015 to December 2016 in Qinghai Provincial People′s Hospital; 236 patients with simple intestinal adhesion had enterolysis（enterolysis group）; 112 patients who were observed bowel necrosis during operation had enterectomy（enterectomy group）. Laboratory data of PCT, WBC, TNF-α and CRP at admission were recorded. The relation between laboratory indicators and occurrence of bowel necrosis was analyzed by the receiver operating characteristic（ROC） curve. Results    Levels of PCT, WBC, TNF-α and CRP in enterolysis group were significantly higher than those in enterectomy group［（26±12）ng/L vs （11±9）ng/L, （13±4）×109/L vs （10±4）×109/L, （171±76）ng/L vs （139±89）ng/L, （110±50）mg/L vs （64±44）mg/L］（P＜0.05）. Areas under the ROC curve of PCT, WBC, TNF-α and CRP were 0.85, 0.70, 0.64 and 0.76; sensitivities of PCT, WBC, TNF-α and CRP in diagnosis of bowel necrosis were 0.848, 0.616, 0.670 and 0.875; specificities of PCT, WBC, TNF-α and CRP in diagnosis of bowel necrosis were 0.762, 0.720, 0.576 and 0.593; Youden indexes of PCT, WBC, TNF-α and CRP were 14.46, 11.91, 132.20 and 5.66, respectively. Conclusion    PCT has a higher value in early diagnosis of bowel necrosis than CRP, WBC and TNF-α in patients with intestinal obstruction.

  【Key words】Intestinal obstruction;Procalcitonin;Leukocyte count;Tumor necrosis factor-α;C-reactive protein;Early diagnosis