摘要
目的探讨血清降钙素原(PCT)在内镜鼻胆管引流术(ENBD)预防老年胆总管结石内镜逆行胆胰管造影(ERCP)术后急性出血坏死型(重型)胰腺炎(AP)的临床诊断价值,以期为临床诊疗提供参考。方法选择2013年1月12日～2018年1月12日我院消化内科收治的老年胆总管多发性结石患者。所有患者均行内镜下ERCP+经十二指肠乳头括约肌切开(EST)取石+留置ENBD术,根据患者术后并发胰腺炎的程度分为急性出血坏死型(重症)胰腺炎(SAP)(观察组,n=48)和急性水肿型(轻型)胰腺炎(MAP)(对照组,n=65)。对比两组患者的一般资料、术后24h外周血PCT、C-反应蛋白(CRP)及血沉(ESR),并分析各项血液学指标对SAP的临床判断价值。结果观察组患者外周血PCT、CRP、ESR均显著高于对照组,差异有统计学意义(P<0.05),ROC曲线分析显示,以0.49μg/ml为截点值,PCT诊断SAP的敏感性为84.37%,特异性为83.03%,曲线下面积为0.856,诊断价值优于CRP及ESR。结论血清PCT对ENBD预防老年胆总管多发性结石ERCP术后SAP的发生具有一定的诊断价值。
Objective To investigate the clinical significance of serum procalcitonin (PCT) in endoscopic nasobiliary drainage (ENBD) in the prevention of acute hemorrhagic necrosis (severe) pancreatitis (AP) after endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients with common bile duct stones judging the value, in order to provide reference for clinical diagnosis and treatment. Methods Patients were admitted to our hospital from Jan 12, 2013 to Jan 12, 2018 were enrolled in the elderly with common bile duct stones. All patients underwent endoscopic ERCP + duodenal papillary sphincter incision (EST) stone removal + indwelling ENBD, according to the severity of postoperative pancreatitis in patients with acute hemorrhagic necrosis (severe) pancreatitis (SAP)(observation group,n=48) and acute edema type (light) pancreatitis (MAP)(control group,n=65). The general conditions of the two groups were compared. The PCT, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) of peripheral blood were compared between the two groups. The clinical judgment value of various hematological parameters on SAP was analyzed. Results Peripheral blood PCT, CRP and ESR in the observation group were significantly higher than the control group (P< 0.05), ROC curve analysis showed that with the cutoff value of 0.49μg/ml, the sensitivity of PCT for diagnosis of SAP was 84.37%, the specificity was 83.03%, and the area under the curve was 0.856. The diagnostic value was better than CRP and ESR. Conclusion Serum PCT has a certain degree of diagnostic value for the prevention of SAP after ERCP in elderly patients with multiple bile duct stones. It has high clinical significance.
作者
崔艳艳
王启之
燕善军
Cui Yanyan;Wang Qizhi;Yan Shanjun(The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004)
出处
《中国现代医药杂志》
2019年第1期31-34,共4页
Modern Medicine Journal of China
关键词
胆总管多发性结石
急性胰腺炎
血清降钙素原
内镜逆行胆胰管造影
内镜鼻胆管引流术
Common bile duct stones
Acute pancreatitis
Serum procalcitonin
Endoscopic retrograde cholangiopancreatography
Endoscopic nasobiliary drainage
