| 郑浩,刘洋,王宁,等.术后早期炎症指标对胰十二指肠切除术后严重胰瘘的预测作用[J].安徽医药,2023,27(3):497-501. |
| 术后早期炎症指标对胰十二指肠切除术后严重胰瘘的预测作用 |
| Postoperative inflammatory biomarkers predict severe pancreatic fistula after pancreaticoduodenectomy |
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| DOI：10.3969/j.issn.1009-6469.2023.03.016 |
| 中文关键词: 胰腺瘘 手术后并发症 胰十二指肠切除术 C反应蛋白 降钙素原 血小板 淋巴细胞 |
| 英文关键词: Pancreatic fistula Postoperative complications Pancreaticoduodenectomy C-reactive protein Procalcitonin Blood Platelets Lymphocytes |
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| 中文摘要: |
| 目的 探讨胰十二指肠切除术(PD)术后早期炎症指标对严重胰瘘的预测作用。方法 回顾性分析2017年8月至2021年4月在中国科学技术大学附属第一医院普外科行胰十二指肠切除术的共117例病人的临床资料。通过查阅病历收集病人的一般资料，术后第1天和第3天的C反应蛋白(CRP)、降钙素原、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)及术后并发症的发生及处理情况。分析严重胰瘘组和非严重胰瘘组间上述指标的差异，利用受试者操作特征曲线(ROC曲线)分析上述指标对严重胰瘘的预测作用。结果 117例行胰十二指肠切除术的病人中B级胰瘘34例，C级胰瘘2例，严重胰瘘26例。严重胰瘘组和非严重胰瘘组间一般资料比较结果显示，两组在年龄、性别、术前体质量指数(BMI)、术前胆红素水平、手术时间、出血量、术前有无胆道引流、病理方面均差异无统计学意义(均P>0.05)。严重胰瘘组与非严重胰瘘组间术后第1天CRP［(104.12±38.73)mg/L比(70.46±30.85)mg/L］，术后第3天CRP［(203.99±59.84)mg/L比(141.08±46.39)mg/L］、NLR［16.55(11.29，21.94)比12.43(8.83，15.64)］、PLR(321.36±154.01比216.40±87.21)差异有统计学意义(均P<0.01)。而两组间术后第1 天降钙素原［(0.97(0.50，1.86)μg/L 比0.78(0.28，1.49)μg/L)］、NLR［(18.35(12.59，25.5)比17.86(12.07，27.18)］、PLR［(384.86(237.86，501.72)比291.53(195.89，412.77)］，术后第3天降钙素原［0.48(0.27，1.36)μg/L比0.50(0.17，0.80)μg/L］差异无统计学意义(均P>0.05)。PD术后第1天CRP，术后第3天CRP、PLR预测严重胰瘘的ROC曲线下面积分别为0.747、0.797、0.711，术后第1天CRP联合术后第3天PLR，术后第3天CRP联合术后第3天PLR预测PD术后严重胰瘘发生的曲线下面积分别为0.839，0.828，对严重胰瘘的发生有较好的预测价值。结论 术后第1天CRP、术后第3天CRP、PLR可有效预测PD术后严重胰瘘的发生风险，对PD术后病人的个体化治疗提供了一定的参考依据。 |
| 英文摘要: |
| Objective To explore the predictive effect of postoperative inflammatory biomarkers on the severe pancreatic fistula af?ter pancreaticoduodenectomy (PD).Methods A retrospective analysis was made of the clinical data of 117 patients who underwent pancreaticoduodenectomy at The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital)from August 2017 to April 2021. We collected patients' general information, C-reactive protein (CRP), procalcitonin (PCT), neutro?phils- lymphocyte ratio (NLR) , platelet-lymphocyte ratio (PLR) on the postoperative day 1 and 3 after PD, and the complications and corresponding measures. The differences in the above indicators between the severe pancreatic fistula group and the non-severe pancre?atic fistula group were analyzed, and the receiver operating curve (ROC) was used to analyze the predictive effect of the above indica?tors on severe pancreatic fistula.Results Among the 117 patients, 34 were grade B pancreatic fistula, 2 were grade C pancreatic fistu?la, and 26 were severe pancreatic fistula. The results of general data comparison between the severe pancreatic fistula group and the non-severe pancreatic fistula group showed that there were no statistical differences in age, gender, body mass index (BMI), preopera?tive total bilirubin, operation time, blood loss, preoperative biliary drainage and pathology between the two groups (all P>0.05). There were statistically significant differences in CRP [(104.12±38.73) mg/L vs. (70.46±30.85) mg/L] on postoperative day 1 (POD1) and CRP[(203.99±59.84) mg/L vs. (141.08±46.39) mg/L], NLR [16.55 (11.29, 21.94) vs. 12.43 (8.83, 15.64)] and PLR [(321.36±154.01) vs.(216.40±87.21)] on postoperative day 3 (POD3) between the two groups (all P<0.01). However, there were no statistically significant dif?ferences in PCT [0.97 (0.50, 1.86)μg/L vs 0.78 (0.28, 1.49)μg/L], NLR [18.35 (12.59, 25.5) vs 17.86 (12.07, 27.18)], PLR [384.86(237.86, 501.72) vs 291.53 (195.89, 412.77)] on POD1 and PCT [0.48 (0.27, 1.36)μg/L vs 0.50 (0.17, 0.80) μg/L] on POD3 between the two groups (all P>0.05). The ROCs of CRP on POD1 and CRP and PLR on POD 3 to predict severe pancreatic fistula were 0.747,0.797, and 0.711, respectively, and the ROCs of CRP on POD1 with PLR on POD 3 and CRP on POD3 with PLR on POD3 to predict severe pancreatic fistula were 0.839 and 0.828, respectively, which had good predictive values for the occurrence of severe pancreatic fistula.Conclusion CRP on POD1, CRP and PLR on POD3 can effectively predict the risk of severe pancreatic fistula after PD, and provide a certain reference for the individualized treatment of patients after PD. |
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