Kuse E R, Langefeld I, Jaeger K, Külpmann W R
Department of Abdominal and Transplantation Surgery, Medizinische Hochschule Hannover, Germany.
Crit Care Med. 2000 Feb;28(2):555-9. doi: 10.1097/00003246-200002000-00044.
Does procalcitonin (PCT) differentiate between infection and rejection after liver transplantation in patients with fever of unknown origin?
Open prospective trial.
Transplant intensive care unit at a university hospital.
Forty patients after liver transplantation.
Liver biopsy for the diagnosis of rejection and transcutaneous aspiration cytology for monitoring of lymphocyte activation.
Procalcitonin from EDTA plasma, Acute Physiology and Chronic Health Evaluation II, and sepsis score.
Eleven patients experienced an infectious complication resulting in an increase in PCT concentrations (2.2-41.7 ng/mL). Eleven patients had a rejection episode; none of these patients showed a rise in PCT concentrations. The statistical difference between PCT concentrations in rejection and infection was significant (p<.05) on the day of diagnosis.
PCT allows for differentiation between rejection and infection in patients with fever of unknown origin. Elevation of PCT plasma concentrations develops early postoperatively from operation trauma, and in the case of fever of unknown origin, with no rise in PCT, a rejection may be suspected.
对于不明原因发热的肝移植患者，降钙素原（PCT）能否区分感染与排斥反应？
开放性前瞻性试验。
某大学医院的移植重症监护病房。
40例肝移植术后患者。
通过肝活检诊断排斥反应，经皮穿刺抽吸细胞学检查监测淋巴细胞活化情况。
EDTA血浆中的降钙素原、急性生理与慢性健康状况评分系统II（APACHE II）以及脓毒症评分。
11例患者发生感染性并发症，导致PCT浓度升高（2.2 - 41.7 ng/mL）。11例患者出现排斥反应；这些患者中无一例PCT浓度升高。诊断当天，排斥反应与感染患者的PCT浓度差异具有统计学意义（p<0.05）。
PCT能够区分不明原因发热的肝移植患者的排斥反应与感染。术后早期，PCT血浆浓度因手术创伤而升高，对于不明原因发热且PCT未升高的患者，可能提示排斥反应。
