Oberhofer Dagmar, Rumenjak Vlatko, Lazić Jasenka, Vucić Niksa
Zavod za anesteziologiju i intenzivno lijecenje, Zagreb, Hrvatska.
Acta Med Croatica. 2006 Dec;60(5):429-33.
Despite recent advances in surgical techniques and intensive care management, infectious complications and sepsis remain significant problem after abdominal surgery. Therefore, inflammatory parameters were looked for that could help achieve an early and more reliable diagnosis of postoperative infections. C-reactive protein (CRP) is a nonspecific inflammatory mediator which is significantly increased postoperatively, regardless of the type of operation and the presence or absence of complications. Procalcitonin (PCT), the prohormone of calcitonin, referred to as a marker of sepsis, is increased significantly in severe bacterial and fungal infections. Quantitative PCT measurements in surgical patients have shown that postoperative PCT concentrations depend on the type and extent of surgery. PCT increased most after major abdominal surgery, although PCT concentrations were significantly higher in patients with complications compared to patients with uneventful postoperative course. The aim of the study was to determine PCT concentrations with a rapid semiquantitative PCT-Q test in the early postoperative period after colon surgery and to investigate its potential use in the diagnosis of infectious complications compared to CRP.
Thirty-eight adult patients undergoing elective surgery of the intestine were followed up. None of the patients had clinical or laboratory signs of infection preoperatively. Leukocytes, CRP and PCT were determined preoperatively and on postoperative days 1-3 and 5. PCT was measured with the B. R. A. H. M. S PCT-Q semiquantitative test. CRP and PCT measurements in 30 patients with normal recovery were statistically analyzed.
CRP was significantly elevated postoperatively in all patients at the 4 time points with maximum values on postoperative day 2. There was no difference in CRP values between patients with and without complications. Although PCT concentration was increased in 15 of 30 patients with normal recovery, only mild increase (>0.5-2 ng/L) was recorded in 13, and moderate increase (>2-10 ng/L) in only two patients. PCT increase was most frequently found on postoperative day 1 or 2, and more rarely on postoperative day 3. The number of patients with elevated PCT was significantly higher (8 of 8 patients) in the group with complications, which included postoperative infections in 7 of 8 patients, than in the group without complications.
In the early postoperative period after major abdominal surgery, CRP is invariably increased and cannot help in recognizing infectious complications. In our study, which included a relatively small number of patients after colon surgery, PCT >2 ng/mL, as measured with semiquantitative PCT-Q test on postoperative days 1-5, or >0.5 ng/ml after postoperative day 3, was rarely recorded in patients with normal postoperative course. We conclude that PCT-Q test can be helpful in the early diagnosis of infectious complications after abdominal surgery.
尽管手术技术和重症监护管理方面最近有所进展，但腹部手术后感染性并发症和脓毒症仍然是重大问题。因此，人们一直在寻找有助于对术后感染进行早期且更可靠诊断的炎症参数。C反应蛋白（CRP）是一种非特异性炎症介质，术后会显著升高，无论手术类型以及有无并发症。降钙素原（PCT），即降钙素的前体激素，被视为脓毒症的标志物，在严重细菌和真菌感染时会显著升高。对手术患者进行的PCT定量测量表明，术后PCT浓度取决于手术类型和范围。大腹部手术后PCT升高最为明显，不过与术后过程平稳的患者相比，有并发症的患者PCT浓度显著更高。本研究的目的是在结肠手术后的早期通过快速半定量PCT-Q检测来测定PCT浓度，并与CRP相比，研究其在感染性并发症诊断中的潜在用途。
对38例接受择期肠道手术的成年患者进行随访。所有患者术前均无感染的临床或实验室迹象。在术前以及术后第1、3和5天测定白细胞、CRP和PCT。使用BRAHMS PCT-Q半定量检测法测量PCT。对30例恢复正常的患者的CRP和PCT测量值进行统计学分析。
所有患者在这4个时间点术后CRP均显著升高，术后第2天达到最大值。有并发症和无并发症的患者CRP值无差异。尽管30例恢复正常的患者中有15例PCT浓度升高，但仅13例记录到轻度升高（>0.5 - 2 ng/L），仅2例记录到中度升高（>2 - 10 ng/L）。PCT升高最常见于术后第1天或第2天，术后第3天较少见。有并发症组（8例患者中有8例）PCT升高的患者数量显著高于无并发症组，其中8例患者中有7例发生了术后感染。
在大腹部手术后的早期，CRP总是升高，无助于识别感染性并发症。在我们这项纳入结肠手术后患者数量相对较少的研究中，术后第1 - 5天使用半定量PCT-Q检测法测得PCT>2 ng/mL，或术后第3天后>0.5 ng/ml，在术后过程正常的患者中很少出现这种情况。我们得出结论，PCT-Q检测有助于腹部手术后感染性并发症的早期诊断。
