血清前降钙素的监测对ERCP术后胰腺炎的诊断价值

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【摘要】目的探讨血清前降钙素（PCT）在经内镜逆行胰胆管造影术（ERCP）术后胰腺炎（PEP）中的水平变化，分析对比PCT、C反应蛋白（CRP）在PEP早期诊断中的临床价值。

方法选择2010年6月至2017年2月行ERCP诊疗胆道结石患者120例。根据COTTON等专家组制定的ERCP术后并发症的定义的共识意见分为PEP组及对照组。实施ERCP诊疗患者术后2 h、6 h、24 h及48 h空腹采血样标本分别行PCT、CRP、血淀粉酶检测。PCT采用双抗体夹心免疫发光法检测，CRP浓度采用快速免疫透射比浊法。采血前未使用影响免疫功能的药物。

结果术后24 h内各时间点两组患者的PCT、CRP水平均逐渐增高（P<0.001），且PEP组患者的PCT、CRP水平均高于对照组（P<0.001），PCT值在24 h达到峰值，后逐渐降低。对于两个指标，分组和时间均存在交互作用（P<0.001）。

结论 PCT、CRP均可作为PEP的独立预测指标，PCT在PEP选择治疗方法和手术时间上提供了更有价值的实验依据，检测方法简单易行、无创，患者及家属易于接受，值得临床推广应用。

【关键词】ERCP术后胰腺炎；前降钙素；C反应蛋白

中图分类号：R657.5+1 文献标识码：ADOI：10.3969/j.issn.10031383.2017.05.002

Diagnostic value of serum procalcitonin monitoring in pancreatitis after ERCP

[HJ2][HJ]

YIN Yixia，HUANG Zansong，HE Shougao，QIN Yueqiu

（Department of Digestive Diseases，Affiliated Hospital of Youjiang Medical University for Nationalities，Baise 533000，China）

[HJ2][HJ]

【Abstract】ObjectiveTo investigate the changes of levels in serum procalcitonin（PCT） in pancreatitis（PEP） after endoscopic retrograde cholangiopancreatography （ERCP），and to compare the clinical value of PCT and Creactive protein（CRP） in the early diagnosis of PEP.

MethodsFrom June，2006 to February，2017，120 patients with biliary calculi were treated with ERCP in our hospital.According to consensus opinion on the definition of postoperative complications of ERCP developed by COTTON and other experts，they were divided into PEP group and control group.And then PCT，CRP and serum amylase were detected in 2 h，6 h，24 h and 48 h fasting blood samples after ERCP diagnosis and treatment.PCT was detected by double antibody sandwich immunoluminescence method，and CRP concentration by rapid immune transmission turbidimetric method.No drugs that affected immune function were used before blood collection.

Results24 h after operation，the levels of PCT and CRP in the two groups gradually increased at each time point（P<0.001），and those the PEP group were higher than those of the control group（P<0.001），the PCT value reached the peak at 24 h and then decreased gradually.There was interaction between grouping and time in the two abovementioned indexes（P<0.001）.

ConclusionPCT and CRP can be used as independent predictors of PEP.PCT provides a more valuable experimental basis for the choice of treatment methods and operation time of PEP.The detection method is simple and noninvasive，and the patients and their families are easy to accept，so it is worthy of clinical application.endprint

【Key words】ERCP postoperative pancreatitis；PCT；CRP

经内镜逆行胰胆管造影术（endoscopic retrogrde cholangioopancreat ography，ERCP）是胆胰疾病的重要诊疗技术之一，无论是诊断性或治疗性ERCP都属于有创性检查，术后可能会出现一些并发症。常见的并发症有ERCP术后胰腺炎（postERCP pancreatitis，PEP）、高淀粉酶血症、出血、穿孔、胆道感染或胆管炎等，其中PEP是最常见的并发症，发生率为2%～40%，且PEP的总体死亡率较高[1]。因此，对于ERCP术后胰腺炎早诊断、早治疗、减轻其严重程度至关重要。本研究旨在检测血清PCT在PEP患者中的变化情况，探讨其在疾病早期诊断中的临床应用价值。

1资料与方法

1.1一般资料

选择2010年6月至2017年2月期间在右江民族医学附属医院住院诊疗，经B超、MRI和MRCP证实为胆管结石并成功实施ERCP、EST及经内镜取石的120例患者，对其临床资料进行回顾性分析，其中男性72例，女性48例，年龄9～98岁，平均（49.2±27.3）岁。……