摘要
目的:研究经皮肾镜取石术(PCNL)术后白细胞值、C反应蛋白(CRP)值及降钙素原(PCT)与急性炎症反应的关系,并筛选出相应临界值与感染的相关性以及对术后感染的预测价值。方法:选取221例肾结石采取经皮肾镜取石碎石术患者。回顾性分析患者术前、术后白细胞值、CRP、PCT,术后出现急性炎症反应的时间、程度。术前尿培养阳性或术后出现高热的患者,给予敏感抗生素至白细胞水平恢复正常。采用SPSS19.3软件进行统计分析,计量资料采用t检验,计数资料采用χ~2检验。结果:术后白细胞升高的患者有101例(45.7%),其术前血白细胞平均水平为(6.41±1.56)×10~9/L,术后第1天血白细胞平均水平为(15.21±3.32)×10~9/L。术后血白细胞值升高而发展为急性炎症反应综合征(SIRS)者有46例(20.8%),其术后第1天血白细胞值较术前升高(8.98±3.86)×10~9/L,SIRS者术后CRP为(61.96±19.59)mg/L,PCT(4.00±0.93)ng/L。ROC曲线分析表明术后第1天血白细胞值、术前术后白细胞绝对差值、术后CRP、术后PCT分别为曲线下面积的0.663、0.646、0.615、0.694,ROC曲线分析得出术后白细胞阈值为13.95×10~9/L、术前术后血白细胞绝对差阈值为9.05×10~9/L、CRP阈值为64.42 mg/L、PCT阈值为3.50 ng/L。结论:PCNL术后易发生感染并发症,严重的感染并发症多经历SIRS期,术后白细胞大于13.95×10~9/L、术前术后血白细胞绝对差值大于9.05×109/L,CRP大于64.42 mg/L、PCT大于3.50 ng/L与严重的感染性并发症发生有密切关系。
Objective：To investigate the relationship between leukocytosis, C-reactive protein, procalcitonin and acute infectious reaction after percutaneous nephrolithotomy（PCNL）, and to determine the critical value for the correlation with infection. Methods： Two hundred and twenty one cases, who underwent PCNL for renal and/or upper ureteral stones were entered in this study. The preoperative and postoperative white blood cell, CRP, PCT changes and the time and degree of acute infectious reaction were retrospectively analyzed after operation. WBC count was followed daily for patients with positive urine culture and/or postoperative fever until leukocyte levels turned to normal limits. For statistical purposes we used SPSS 19.3 （IBM）. Statistical analyses were performed using the independent t test, andthe chi-square test.Results：Leukocytosis was detected in 101 patients（45.7%）. The mean preoperative and postoperative WBC counts in day 1 were （6.41±1.56）×10^9/L and （15.21±3.32）×10^9/L, respectively. Forty-six cases （45.5%） with postoperative leukocytosis developed into systemic inflammatory response syndrome（SIRS）, whose the average postoperative WBC count increased by （8.98±3.86）×10^9/L on the postoperative day 1, the average CRP and PCT up to （61.96±19.59）mg/L and （4.00±0.93）ng/L, respectively. Receiver operating characteristic（ROC） curve analysis demonstrated the area under the curve were 0.663, 0.646, 0.615 and 0.694 for postoperative WBC count, the difference of pre-postoperative WBC count, CRP and PCT, respectively. The thresholds provided by the analysis were 13.95×10^9/L, an increase greater than 9.05×10^9/L, 64.42mg/L and 3.50ng/L, respectively.Conclusion：Patients who undergoes PCNL are more likely to have infection complication, and the serious infection may occur through the stage of SIRS. Our data shows that 13.95×10^9/L WBC count, absolute difference in WBC count from baseline of 9.05×10^9/L, 64.42mg/L CRP and 3.50ng/L PCT are significantly assoc
出处
《天津医科大学学报》
2017年第2期108-112,共5页
Journal of Tianjin Medical University
基金
国家自然科学基金资助项目(81400686)
