PCR法快速诊断急性重症胰腺炎早期合并细菌感染

目的探讨以16srRNA基因为基础的细菌聚核酶链反应（PCR）法诊断急性重症胰腺炎早期合并细菌感染的价值。方法收集17例急性重症胰腺炎患者（女13例，男4例，年龄17～79岁）不同时期、不同部位标本45份，其中17份来自细针穿刺（FNA），28份为术中标本。获取胰周渗液后，行细嚣通用引物PCR法检测。并与常规细菌培养结果进行比较。结果10例最终诊断为胰腺感染，并行手术治疗；7例最终诊断为胰腺未感染，5例经保守治疗治愈，2例死亡。常规培养阳性检出率为84．4％；细菌PCR法阳性检出率为80％。PCR、培养诊断胰腺感染的敏感性分别为90％（9／10）、100％（10／10），特异性均为100％（7／7）。两者耗时分别为5h、3d。结论B超引导细针穿刺安全可行；PCR法能快速、准确地诊断急性重症胰腺炎早期合并细菌感染，为手术治疗提供可靠依据。

Rapid Diagnosis of Severe Acute Pancreatitis Complicated with Bacterial Infection by Polymerase Chain Reaction

Objective To explore the diagnostic value of 16s rRNA gene based bacteria polymerase chain reaction(PCR) method in severe acute pancreatitis early complicated with bacterial infection.Methods The peripancreatic fluid from patients(13 females and 4 males,aged between 17 y and 79 y) with severe acute pancreatitis were obtained by ultrasound-guided percutaneous fine needle aspiration(FNA).Forty-five samples from 17 severe acute pancreatitis cases were obtained.The PCR assay was used to detect bacteria and compared with convention culture.ResultsTen patients were diagnosed as pancreatic infection and operated on7 patients were diagnosed as non-pancreatic infection,5 of those were cured by non surgery therapy;2 patients were died,17 samples was from FNA,28 samples from operation.The positive detection rate of convention culture was 84.4%,while that of PCR assay was 80%.The sensitivity of PCR and culture to diagnosis of pancreatic infection was 90%(9/10)and 100%(10/10),respectively.Their specificity was 100%(7/7).The time for obtaining the results was five hours and three days,respectively.Conclusion Ultrasound-guided percutaneous fine needle aspiration was safe and feasible.The PCR method was rapid and accurate way in the diagnosis of severe acute pancreatitis early complicated with bacterial infection and could offer faithful proof for operation.