Molter G P, Soltész S, Kottke R, Wilhelm W, Biedler A, Silomon M
Klinik für Anaesthesie und operative Intensivmedizin, Klinikum Leverkusen gGmbH, Leverkusen.
Anaesthesist. 2003 Mar;52(3):210-7. doi: 10.1007/s00101-003-0460-8.
Procalcitonin (PCT) is currently recommended as a suitable parameter to detect and to evaluate the course of bacterial, fungal or parasitic infections. However, recent studies provide evidence that surgical trauma and humoral mediators of inflammation, respectively,may induce PCT synthesis, thereby reducing the validity and reliability of PCT as an "infection-monitoring" parameter. The aim of the present study was to assess and to compare PCT and CRP (C-reactive protein) plasma concentrations in patients presenting without infection following different types of surgery in the absence or presence of a systemic inflammatory response syndrome (SIRS).
PCT and CRP plasma concentrations were assessed daily on postoperative days 1-5 and maximal values were determined in 94 patients. The patients were allocated to four groups of different types of surgery as follows: A: minor, primarily aseptic surgery, B: major abdominal surgery, C: major vascular surgery and D: thoracic surgery including esophagectomy. All categories were divided into two subgroups representing patients with and without SIRS, respectively. RESULTS. PCT plasma concentrations increased moderately compared to normal values in 21% of patients after minor and aseptic surgery (A), in 27% and 41% after major vascular (C) and thoracic (D) surgery, respectively, and in 65% of patients after major abdominal (B) surgery. The difference between PCT concentrations in patients undergoing major abdominal surgery and the patients after minor, aseptic surgery was significant ( p<0,05: A vs. B). Comparing the patients presenting with or without systemic inflammatory response (SIRS), no significant differences in PCT concentrations between groups could be observed. In the majority of patients PCT values rose to peak levels on the first and second postoperative days, followed by a rapid decline based on the plasma half-life of PCT. In contrast, postoperative CRP plasma concentrations were markedly elevated above normal values in all investigated patients during the whole observation period. Between-categories statistical analysis revealed significant differences comparing patients undergoing minor and aseptic surgery with patients after major vascular, and thoracic surgery, respectively ( p<0,05,A vs.C, D). CRP concentrations were significantly increased in patients with systemic inflammatory response compared to patients with normal postoperative course in surgical categories B, C, and D, respectively ( p<0,05).
Postoperative PCT plasma concentrations in patients presenting without signs of infection are largely influenced by the type of surgical procedure. During the first and second postoperative day PCT concentrations are more frequently elevated in patients after major abdominal, major vascular and thoracic surgery compared to patients undergoing minor, aseptic operations. Thus an "infection monitoring" considering PCT value analysis during the postoperative course may transiently be impeded after major and particularly after intestinal surgery during the first 2 days postoperatively, whereas it appears not to be substantially affected by the presence or absence of systemic inflammatory response.
目前推荐降钙素原（PCT）作为检测和评估细菌、真菌或寄生虫感染病程的合适参数。然而，最近的研究表明，手术创伤和炎症体液介质可能分别诱导PCT合成，从而降低PCT作为“感染监测”参数的有效性和可靠性。本研究的目的是评估和比较在无全身炎症反应综合征（SIRS）或有SIRS的情况下，不同类型手术后无感染患者的PCT和C反应蛋白（CRP）血浆浓度。
在术后1 - 5天每天评估PCT和CRP血浆浓度，并确定94例患者的最大值。患者被分为四组不同类型的手术：A组：小型、主要为无菌手术；B组：大型腹部手术；C组：大型血管手术；D组：包括食管切除术的胸科手术。所有类别又分别分为有SIRS和无SIRS的两个亚组。结果：小型无菌手术后21%的患者PCT血浆浓度与正常值相比适度升高（A组），大型血管（C组）和胸科（D组）手术后分别为27%和41%，大型腹部（B组）手术后为65%。大型腹部手术患者与小型无菌手术患者的PCT浓度差异显著（p<0.05：A组与B组）。比较有或无全身炎症反应（SIRS）的患者，各组间PCT浓度无显著差异。大多数患者的PCT值在术后第1天和第2天升至峰值水平，随后基于PCT的血浆半衰期迅速下降。相比之下，在整个观察期内，所有研究患者术后CRP血浆浓度均明显高于正常值水平。组间统计分析显示，小型无菌手术患者与大型血管和胸科手术后患者相比有显著差异（p<0.05，A组与C组、D组）。在手术类别B、C和D中，有全身炎症反应的患者CRP浓度分别比术后病程正常的患者显著升高（p<0.05）。
无感染迹象患者的术后PCT血浆浓度在很大程度上受手术类型影响。与小型无菌手术患者相比，大型腹部、大型血管和胸科手术后患者在术后第1天和第2天PCT浓度更频繁升高。因此，在术后病程中考虑PCT值分析的“感染监测”在大型手术尤其是肠道手术后的头2天可能会受到短暂阻碍，而它似乎基本不受全身炎症反应存在与否的影响。
