用降钙素原和白细胞联合能预测心脏手术病人的感染

为了探讨通过结合C反应蛋白(C-reactive protein, CRP)、白细胞(leukocyte, WBC)和降钙素原(procalcitonin, PCT)来预测大批心脏病手术患者术后感染的可行性,本研究病例对照研究涉及423例接受心肺心脏搭桥手术的心脏病患者。基于在术后期间是否有严重的败血症或化脓性休克,病人被分成两组。在重症监护病房的第1天,提取用于生物测量(PCT, CRP和WBC)的血液样本,然后每天早上提取1次,直到术后第10天。研究发现,两组群体的CRP中值类似。在10 d术后期间,感染病人群体中的WBC和PCT中值明显比未感染的群体高。高程截止≤3次(概率:4.058, 95%置信区间:2.206～7.463; p=0.001)和高程截止≥4次(概率:10.274, 95%置信区间:3.690～28.604; p<0.001),在术后第2天,随着感染的发展,PCT中值(1.7 ng/mL)和/或WBC中值(13 000个细胞/mm3)发生了明显的变化。本研究初步表明,在术后前3 d,PCT和WBC水平结合,能够预测接下来30 d心脏手术的术后感染情况,具有一定的临床应用价值。

Prediction of Infection in Cardiac Surgery Patients by Combination of Procalcitonin and Leukocyte

In order to explore the feasibility of predicting postoperative infection in large number of heart surgery patients by combining C-reactive protein(CRP), leukocyte(WBC) and Procalcitonin(PCT), the case-control study of this study involved 423 patients with heart disease undergoing cardiopulmonary bypass surgery. The patients were divided into two groups based on whether they had severe sepsis or were septic shock during the postoperative period. On the first day in the intensive care unit, blood samples were extracted for biological measurements(PCT,CRP and WBC) and were extracted once every morning until the 10 thday after surgery. It was found that the CRP median of the two groups was similar. During the 10-days postoperative period, the WBC and PCT medians in the infected patients were significantlyhigher than those in the uninfected patients. Elevation cut-off ≤3 times(probability:4.058, 95% confidence interval: 2.206~7.463;p=0.001) and elevation cutoff ≥4 times(probability: 10.274, 95%confidence interval: 3.690~28.604;p<0.001). On the 2 ndday after the operation, with the development of infection,the PCT median(1.7 ng/mL) and/or WBC median(13 000 cells/mm3) had undergone significant changes. Our study preliminarily showed that the combination of PCT and WBC levels in the first 3 days after operation could effectively predict postoperative infection of cardiac surgery in the next 30 days and would have certain clinical application value.