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降钙素原在监测高龄患者体外循环心脏术后早期并发症的应用研究

ISSN号：1007-9688
期刊名称：《岭南心血管病杂志》
时间：0
分类：R654.1[医药卫生—临床医学;医药卫生—外科学]
作者机构：[1]佛山市第一人民医院心外科,广东佛山528000
相关基金：佛山市卫生局课题（课题编号：2010018）.

作者：简劲峰[1], 封加涛[1], 彭峰[1], 苏艳玲[1], 叶华安[1], 林家旺[1]

关键词：心脏手术, 降钙素原, 体外循环, 早期并发症, cardiac surgery , procalcitonin , cardiopulmonary bypass , early complication

中文摘要：

目的通过测定高龄患者体外循环心脏术后的降钙素原（procalcitonin,PCT）,了解PCT的变化规律及其和其他炎性因子的相关性,评价PCT对提示高龄患者体外循环心脏术后早期并发症的应用价值。方法选取32例60岁以上体外循环下手术患者为研究对象。分别测定术前、转流前、手术结束、术后4 h、术后24 h、术后48 h和术后72 h七个不同时间点的白细胞计数、C反应蛋白、白细胞介素（interleukin,IL）-6、IL-8、肿瘤坏死因子-α和PCT数值。结果 PCT于体外循环结束开始升高,术后48 h可达到峰值,术后72 h逐渐下降。PCT与其他炎性因子的相关性分析结果显示,PCT与白细胞计数（r=0.938,P=0.002）、肿瘤坏死因子-α（r=0.950,P=0.001）和IL-8（r=0.930,P=0.003）相关性最高,其次为IL-6（r=0.883,P=0.012）,与CRP（r=0.673,P=0.113）相关性最小。术后早期发生并发症患者术后24 h、48 h、72 h的PCT浓度高于术后无并发症患者,差异有统计学意义[（3.25±1.05）ng/mL vs.（1.88±0.87）ng/mL,P〈0.05;（4.87±1.54）ng/mL vs.（2.13±0.90）ng/mL,P〈0.05;（8.25±1.70）ng/mL vs.（1.10±0.38）ng/mL,P〈0.01]。结论PCT是一种早期的、敏感性和特异性极佳的高危监测指标;测定PCT有助于临床鉴别心脏术后高危患者。

英文摘要：

Objectives To explore the change of procalcitonin （PCT） level and the relation between PCT and other cytokines, and to research the value of PCT to indicate early complication by testing PCT after cardiopulmonary bypass （CPB） operation in elderly patients. Methods Thirty-two cases aged more than 60 undergone CPB operation were chosen in this study. Blood samples were taken before surgery, before CPB, at the end of surgery, 4 hours after surgery, 24 hours after surgery, 48 hours after surgery and 72 hours after surgery to detect levels of white blood cells （WBC）, C-reactive protein （CRP）, interleukin （IL）-6, IL-8, tumor necrosis factor-a （TNF-a） and PCT. Results The level of PCT increased after CPB operation, reached its peak level at 48 hours after the surgery and decreased from 72 hours after the surgery. The level of PCT was most significantly correlated with WBC （r=0.938,P=0.002）, TNF-ct （r=0.950, P=0.001） and IL-8 （r=0.930, P=0.003）, less significantly correlated with IL-6 （r=0.883, P=0.012）, while the lest significantly correlated with CRP （r=0.673, P=0.113）. The levels of PCT in patients with complication at 24 hours, 48 hours and 72 hours after operation were significantly higher than those in patients without complication [ （3.25 ±1.05） ng/mL vs.（1.88±0.87） ng/mL,P〈0.05 ; （4.87±1.54） ng/mL vs. （2.13±0.90） ng/mL,P〈0.05; （8.25±1.70） ng/mL vs.（1.10±0.38） ng/mL, P〈0.01 ]. Conclusions PCT detection is an early, specific and sensitive diagnostic method to identify high-risk patients after cardiac surgery.

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