降钙素原在伴有发热症状的克罗恩病中的作用：一种有助于鉴别腹内脓肿与疾病活动的变量。

Procalcitonin in Crohn's disease with fever episodes, a variable to differentiate intra-abdominal abscess from disease flares.

机构信息

Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.

Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Surgery, The First Affiliated Hospital of Nanchang University, China.

出版信息

Int J Surg. 2016 Dec;36(Pt A):34-39. doi: 10.1016/j.ijsu.2016.10.011. Epub 2016 Oct 12.

DOI:10.1016/j.ijsu.2016.10.011

PMID:27743896

Abstract

BACKGROUND

Crohn's Disease (CD) is a chronic inflammatory disease accompanied by many complications, such as intra-abdominal abscess (IAA). A frequent problem in CD is the discrimination of fever caused by exacerbated bowel inflammation or IAA.

METHODS

A total of 80 CD patients complaining with fever episodes were included prospectively. PCT, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell count (WBC) were evaluated on admission. IAA was identified based on image studies and response to antibiotic therapy by physicians blind to the serum PCT level. At last, correlation between serum PCT level and patients' disease activity was also investigated.

RESULTS

Sixteen patients were identified with IAA, which showed significantly higher serum PCT level when compared with those patients who have no IAA (0.505 ng/ml vs 0.112 ng/ml, p < 0.01). PCT is a better biomarker of IAA in CD patients compared with CRP, ESR and WBC (AUC = 0.954, 0.757, 0.771 and 0.554, respectively). And the cutoff value for PCT in differentiating patients with and without IAA was 0.35 ng/ml. Correlation between serum PCT level and CDAI score (r = 0.575) was weaker than that of CRP and ESR (r = 0.628 and 0.634 respectively), but stronger than that of WBC (r = 0.162).

CONCLUSION

PCT can be an additional marker for detecting IAA in CD patients with fever episodes, and may serve as a new serological marker of disease activity.

摘要

背景

克罗恩病（CD）是一种伴有多种并发症的慢性炎症性疾病，如腹腔内脓肿（IAA）。CD 患者经常面临的一个问题是区分由肠道炎症加重或 IAA 引起的发热。

方法

前瞻性纳入 80 例主诉发热的 CD 患者。入院时评估降钙素原（PCT）、C 反应蛋白（CRP）、红细胞沉降率（ESR）和白细胞计数（WBC）。根据影像学研究和医生对血清 PCT 水平不知情的抗生素治疗反应来确定 IAA。最后，还研究了血清 PCT 水平与患者疾病活动度之间的相关性。

结果

16 例患者被诊断为 IAA，与无 IAA 的患者相比，血清 PCT 水平明显更高（0.505ng/ml 比 0.112ng/ml，p<0.01）。与 CRP、ESR 和 WBC 相比，PCT 是 CD 患者 IAA 的更好生物标志物（AUC 分别为 0.954、0.757、0.771 和 0.554）。区分有和无 IAA 的患者的 PCT 截断值为 0.35ng/ml。血清 PCT 水平与 CDAI 评分之间的相关性（r=0.575）弱于 CRP 和 ESR（r 分别为 0.628 和 0.634），但强于 WBC（r=0.162）。