内毒素活性测定在胆道感染中的严重程度及预后评估

Severity and prognostic assessment of the endotoxin activity assay in biliary tract infection.

作者信息

Sato Mari, Matsuyama Ryusei, Kadokura Toshiaki, Mori Ryutaro, Kumamoto Takafumi, Nojiri Kazunori, Taniguchi Koichi, Takeda Kazuhisa, Kubota Kensuke, Tanaka Kuniya, Endo Itaru

机构信息

Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawaku, Yokohama, 239-0004, Japan.

出版信息

J Hepatobiliary Pancreat Sci. 2014 Feb;21(2):120-7. doi: 10.1002/jhbp.10. Epub 2013 Jun 20.

DOI:10.1002/jhbp.10

PMID:23798326

Abstract

BACKGROUND

Acute cholangitis and cholecystitis (AC) often progress to severe septic conditions. We evaluated the endotoxin activity assay (EAA) for assessment and prediction of the severity of AC.

METHODS

We retrospectively reviewed 98 patients diagnosed with AC. We divided them into low (<0.4) and high (≥0.4) groups based on EAA values.

RESULTS

Endotoxin levels showed no correlation with EAA values. Serum C-reactive protein (8.57 vs. 5.23 mg/dl, P = 0.02), procalcitonin (2.45 vs. 0.48 ng/ml, P = 0.004), and the positive culture rate of blood (50% vs. 15%, P < 0.001) were significantly higher in the high group than in the low group. Platelet counts were significantly lower in the high group than in the low group (23.9 vs. 13.5 10(4) /ml, P = 0.004). The ratio of patients with a Japanese Association for Acute Medicine disseminated intravascular coagulation score ≥4 (32% vs. 14%, P = 0.032) was significantly higher in the high group than in the low group. There was a significantly higher percentage of patients with a severe grade of AC in the high group than patients with a mild or moderate grade (32% vs. 15%, P = 0.05).

CONCLUSIONS

Endotoxin activity assay is useful for assessment and early prediction of septic conditions due to AC.

摘要

背景

急性胆管炎和胆囊炎（AC）常进展为严重的脓毒症状态。我们评估了内毒素活性测定（EAA）用于AC严重程度的评估和预测。

方法

我们回顾性分析了98例诊断为AC的患者。根据EAA值将他们分为低（<0.4）和高（≥0.4）两组。

结果

内毒素水平与EAA值无相关性。高组血清C反应蛋白（8.57对5.23mg/dl，P = 0.02）、降钙素原（2.45对0.48ng/ml，P = 0.004）和血培养阳性率（50%对15%，P < 0.001）显著高于低组。高组血小板计数显著低于低组（23.9对13.5×10⁴/ml，P = 0.004）。日本急性医学协会弥散性血管内凝血评分≥4的患者比例在高组显著高于低组（32%对14%，P = 0.032）。高组AC重度患者的比例显著高于轻度或中度患者（32%对15%，P = 0.05）。