Cosse C, Sabbagh C, Browet F, Mauvais F, Rebibo L, Zogheib E, Chatelain D, Kamel S, Regimbeau J M
Department of Digestive and Oncological Surgery, Amiens North Hospital, University of Picardie, Place Victor Pauchet, 80054, Amiens Cedex 01, France.
INSERM U1088, Jules Verne University of Picardie, Amiens, France.
Surg Endosc. 2015 Nov;29(11):3132-9. doi: 10.1007/s00464-014-4038-0. Epub 2015 Feb 21.
Ischemic and necrotic damages are complications of digestive diseases and require emergency management. Nevertheless, the decision to surgically manage could be delayed because of no sufficiently preoperative accurate marker of ischemia diagnosis, extension, and prognosis.
The aim of this study was to assess the predictive value of serum procalcitonin (PCT) levels for diagnosing intestinal necrotic damages, their extension, and their prognosis in patients with ischemic disease including ischemic colitis and mesenteric infarction by a gray zone approach. Between January 2007 to June 2014, 128 patients with ischemic colitis and mesenteric infarction (codes K55.0 and K51.9) were operated, for whom data on PCT were available. We perform a retrospective, multicenter review of their medical records. Patients were divided into subgroups: ischemia (ID group) versus necrosis (ND group); the extension [focal (FD) vs. extended (ED)] and the vital status [deceased (D) vs. alive (A)].
PCT levels were higher in the ND (n = 94; p = 0.009); ED (n = 100; p = 0.02); and D (n = 70; p = 0.0003) groups. With a gray zone approach, the predictive thresholds were (i) for necrosis 2.473 ng/mL, (ii) for extension 3.884 ng/mL, and (iii) for mortality 7.87 ng/mL.
In our population, PCT could be used as a marker of necrosis; especially in case of extended damages and reflects the patient's prognosis.
缺血性和坏死性损伤是消化系统疾病的并发症，需要紧急处理。然而，由于术前缺乏足够准确的缺血诊断、范围及预后标志物，手术治疗的决策可能会延迟。
本研究旨在通过灰色区域法评估血清降钙素原（PCT）水平对诊断包括缺血性结肠炎和肠系膜梗死在内的缺血性疾病患者肠道坏死性损伤、损伤范围及预后的预测价值。2007年1月至2014年6月期间，128例缺血性结肠炎和肠系膜梗死（编码K55.0和K51.9）患者接受了手术，且有PCT数据。我们对他们的病历进行了回顾性多中心分析。患者被分为亚组：缺血组（ID组）与坏死组（ND组）；损伤范围[局灶性（FD）与广泛性（ED）]；生命状态[死亡（D）与存活（A）]。
ND组（n = 94；p = 0.009）、ED组（n = 100；p = 0.02）和D组（n = 70；p = 0.0003）的PCT水平较高。采用灰色区域法，预测阈值分别为：（i）坏死为2.473 ng/mL，（ii）范围为3.884 ng/mL，（iii）死亡率为7.87 ng/mL。
在我们的研究人群中，PCT可作为坏死的标志物；尤其是在广泛性损伤的情况下，并可反映患者的预后。
