降钙素原对小儿粘连性小肠梗阻（ASBO）肠缺血和/或坏死的预测价值。

Predictive value of procalcitonin for intestinal ischemia and/or necrosis in pediatric patients with adhesive small bowel obstruction (ASBO).

作者信息

Bracho-Blanchet Eduardo, Dominguez-Muñoz Alfredo, Fernandez-Portilla Emilio, Zalles-Vidal Cristian, Davila-Perez Roberto

机构信息

Departamento de Cirugía General, Hospital Infantil de México Federico Gómez, Dr. Marquez 162 Col. Doctores, CP, 06720, México, D.F., Mexico.

出版信息

J Pediatr Surg. 2017 Oct;52(10):1616-1620. doi: 10.1016/j.jpedsurg.2017.07.006. Epub 2017 Jul 13.

DOI:10.1016/j.jpedsurg.2017.07.006

PMID:28735976

Abstract

PURPOSE

Evaluate serum procalcitonin (PCT) level as a predictor of intestinal ischemia or necrosis (IN) in patients with postoperative adhesive small bowel obstruction (ASBO).

METHODS

Prospective cohort of consecutive patients with ASBO. Patients previously treated with antibiotics or septic were excluded. PCT was measured at the diagnosis of ASBO and every 24 h afterwards.

MAIN OUTCOME

intestinal ischemia or necrosis (IN).

RESULTS

Fifty-nine patients were included, 12 of whom were excluded; 47 patients remained in the study; male-to-female ratio = 1.9:1.

MANAGEMENT

medical in 15 cases (32%) and surgical in 32 (68%).

MAIN OUTCOME

Intestinal necrosis (IN) in 10 patients (21.3%). Mean PCT level was higher in patients with IN (15.11 ng/ml vs. 0.183 ng/ml, p=0.002), the proportion of patients with elevated PCT (>0.5 ng/dl) was higher in patients with IN (70% vs. 8.1%, p=<0.001, RR=26.4 with a 95% CI of 4.39-159.5). Elevated PCT levels at diagnosis had a 70% positive predictive value (PPV) and 91.8% negative predictive value (NPV) for prediction of IN. With a PCT value at diagnosis of >1.0 ng/dl, PPV was 87.5% and NPV, 92.3%.

CONCLUSIONS

PCT levels are closely related to the presence of intestinal ischemia and necrosis in children with ASBO.

LEVEL OF EVIDENCE

Study of Diagnostic Test, Level II.

摘要

目的

评估血清降钙素原（PCT）水平作为术后粘连性小肠梗阻（ASBO）患者肠缺血或坏死（IN）的预测指标。

方法

对连续性ASBO患者进行前瞻性队列研究。排除既往接受过抗生素治疗或患有败血症的患者。在ASBO诊断时及之后每24小时测量PCT。

主要结局

肠缺血或坏死（IN）。

结果

纳入59例患者，其中12例被排除；47例患者继续参与研究；男女比例为1.9:1。

治疗方式

15例（32%）采用内科治疗，32例（68%）采用外科治疗。

主要结局

10例患者（21.3%）发生肠坏死（IN）。IN患者的平均PCT水平更高（15.11 ng/ml对0.183 ng/ml，p = 0.002），IN患者中PCT升高（>0.5 ng/dl）的比例更高（70%对8.1%，p<0.001，RR = 26.4，95%CI为4.39 - 159.5）。诊断时PCT水平升高对IN的预测阳性预测值（PPV）为70%，阴性预测值（NPV）为91.8%。诊断时PCT值>1.0 ng/dl，PPV为87.5%，NPV为92.3%。