降钙素原与C反应蛋白早期预测腹腔镜结直肠癌术后吻合口漏的临床价值

目的探讨降钙素原(PCT)及C反应蛋白(CRP)早期预测腹腔镜结直肠癌术后吻合口漏的临床价值。方法前瞻性入组2019年3月至2019年10月间华中科技大学同济医学院附属协和医院胃肠外科收治的行腹腔镜结直肠癌手术的病人。分别于术前及术后第1、3、5、7天检测病人血清PCT、CRP、白细胞计数(WBC)、中性粒细胞计数(NEUT)水平,根据术后是否发生吻合口漏分为吻合口漏组与非吻合口漏组。比较两组不同时间点血清PCT、CRP、WBC、NEUT水平的差异,根据受试者工作特征曲线(ROC)评价和比较PCT、CRP、WBC对吻合口漏预测的准确性,并计算其敏感度、特异度及最佳临界值。采用DeLong测试计算两条ROC曲线下面积(AUC)之差,并进行AUC间的比较。结果共入选112例行腹腔镜结直肠癌手术病人,术后8例(7.14%)发生吻合口漏,吻合口漏组术后血清PCT、CRP水平显著高于非吻合口漏组。PCT、CRP预测术后吻合口漏的准确性均优于WBC;CRP在各时间点中术后第3天预测吻合口漏准确性最高;PCT在术后第3、5天预测吻合口漏准确性均优于术后第3天CRP预测吻合口漏准确性;术后第3、5天PCT预测吻合口漏的AUC比较,两者差异无统计学意义(P=0.664)。术后第3天PCT预测吻合口漏敏感度为87.5%,特异性为86.5%,阳性预测值为31.8%,最佳临界值为1.26μg/L;术后第5天PCT预测吻合口漏敏感度为87.5%,特异性为76.9%,阳性预测值为22.6%;术后第3天PCT预测吻合口漏的特异性与阳性预测值优于术后第5天。术后第3、5天PCT联合CRP预测吻合口漏的AUC分别为0.903、0.888,术后第3天单独PCT预测吻合口漏的AUC与术后第3天PCT联合CRP预测吻合口漏的AUC相比,两者差异无统计学意义(P=0.135)。结论动态监测术后血清PCT和CRP水平可有效预测腹腔镜结直肠癌手术后吻合口漏的发生。术后第3天血清PCT水平对早期预测吻合口漏有很高的临床价值,当术后第3天血清PCT>1.26μg/L时,应高度警惕吻合口漏发生的可能。

Clinical value of procalcitonin and C reactive protein in early predicting anastomotic leakage after laparoscopic colorectal cancer surgery

Objective To investigate the clinical value of procalcitonin(PCT)and C-reactive protein(CRP)in early prediction of anastomotic leakage(AL)after laparoscopic colorectal cancer surgery.Methods Patients who underwent laparoscopic colorectal cancer surgery in Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from March 2019 to October 2019 were prospectively enrolled.Serum PCT,CRP,white blood cell count(WBC),and neutrophil count(NEUT)levels were measured before surgery and on postoperative days 1,3,5,and 7.According to the definition of AL,patients were divided into AL group and non-AL group.The differences of serum PCT,CRP,WBC and NEUT levels in the two groups at different time points were compared.The predictive accuracy of PCT,CRP and WBC for AL were evaluated according to the receiver operating characteristic curve(ROC),and their sensitivity,specificity and optimal critical value were also calculated.DeLong test was used to calculate and compare the difference of AUC under two ROC curves.Results A total of 112 patients who underwent laparoscopic colorectal cancer surgery were enrolled,and 8 patients(7.14%)developed AL after operation.The serum PCT,CRP levels of AL group were higher than those of non-AL group.The accuracy of PCT and CRP in predicting AL was better than that of WBC.CRP had the highest accuracy in predicting AL on the 3rd postoperative day.The accuracy of PCT in predicting AL on the 3rd and 5th postoperative day was better than that of CRP on the 3rd postoperative day.There was no significant difference in the AUC of AL predicted by PCT on the 3rd and 5th postoperative day(P=0.664).The sensitivity of PCT on the 3rd postoperative day was 87.5%,the specificity was 86.5%,the positive predictive value was 31.8%,and the optical cut-off value was 1.26μg/L;the sensitivity of PCT on the 5th postoperative day was 87.5%,the specificity was 76.9%,and the positive predictive value was 22.6%.The specificity and positive predictive value of PCT to predict AL on the 3rd postoperative day were better than those on the 5th postoperative day.The AUC of PCT combined with CRP in predicting AL on the 3rd and 5th postoperative day were 0.903 and 0.888,respectively.There was no significant difference between the AUC of PCT alone and that of PCT combined with CRP on the 3rd postoperative day(P=0.135).Conclusion Dynamic monitoring of postoperative serum PCT and CRP levels can effectively predict the occurrence of anastomotic leakage after laparoscopic colorectal cancer surgery.Serum PCT levels on postoperative day 3 are of high clinical value for early prediction of anastomotic leakage,and the possibility of anastomotic leakage should be highly vigilant when serum PCT>1.26μg/L on postoperative day 3.