Pettit S H, Holbrook I B, Irving M H
Br J Surg. 1985 Dec;72(12):1013-6. doi: 10.1002/bjs.1800721226.
Fifty-two patients with Crohn's disease have been assessed using acute phase proteins and a scoring system. Thirty-nine underwent operation and intra-abdominal abscesses were found in seventeen. Both scores and acute phase proteins have been shown to reflect inflammation due to secondary sepsis in addition to that from active Crohn's disease. The scores were higher, and acute phase changes greater, in patients with sepsis than those without. By choosing a threshold for each variable that excludes patients without sepsis it has been found that a score greater than 181, ESR greater than 45 mm/h, CRP greater than 33 mg/l, orosomucoid greater than 1.8 g/l and albumin less than 26.7 g/l identify sepsis with a specificity greater than 95 per cent and sensitivity greater than 35 per cent. Over 70 per cent of patients with abscesses exceeded one or more of these thresholds. We believe that operative management should be strongly considered if one or more of these criteria are positive as such patients have a greater than 90 per cent chance of having an intra-abdominal abscess. This will prevent these abscesses eroding into adjacent viscera or to the surface with resulting fistula formation.
采用急性期蛋白和评分系统对52例克罗恩病患者进行了评估。39例患者接受了手术，其中17例发现有腹腔内脓肿。结果显示，评分和急性期蛋白除了能反映活动性克罗恩病引起的炎症外，还能反映继发脓毒症所致的炎症。脓毒症患者的评分更高，急性期变化更大。通过为每个变量选择一个排除无脓毒症患者的阈值，发现评分大于181、血沉大于45mm/h、C反应蛋白大于33mg/l、类黏蛋白大于1.8g/l以及白蛋白小于26.7g/l时，诊断脓毒症的特异性大于95%，敏感性大于35%。超过70%的脓肿患者超过了上述阈值中的一项或多项。我们认为，如果这些标准中的一项或多项为阳性，则应强烈考虑手术治疗，因为这类患者发生腹腔内脓肿的几率大于90%。这将防止这些脓肿侵蚀相邻脏器或穿至体表，从而形成瘘管。
