血清肾上腺髓质素前体在闭合性小肠破裂患者预后评估中的作用

目的 通过动态监测闭合性小肠破裂患者血清肾上腺髓质素前体(pro-adrenomedullin,pro-ADM)水平,探讨此类患者术前血清pro-ADM水平与术后继发腹腔感染之间的关系;以及术后血清pro-ADM水平对其术后腹腔感染严重程度的评估价值.方法 选取安徽医科大学第二附属医院急诊外科2014年6月至2015年5月收治的85例闭合性小肠破裂患者;并依据患者术后是否发生腹腔感染,分感染组及无感染组;感染组依据其感染严重程度分为SIRS,脓毒症,严重脓毒症,脓毒症休克四组.分别于患者入院时及患者术后第1、3、5天检测血清pro-ADM、白细胞介素-6(IL-6)、C-反应蛋白(CRP)水平并行急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分.比较患者入院时各组指标之间的差异性及相关性,并通过对各指标预测患者术后发生腹腔感染进行ROC曲线阈值分析,比较各指标对此类患者术后发生腹腔感染预测价值.并对术后血清pro-ADM水平及APACHEⅡ评分结果进行相关性分析,比较两者对患者术后腹腔感染严重程度的评估价值.结果 入院时及术后感染组血清pro-ADM (P=0.03,P＜0.01)、IL-6 (P =0.02,P＜0.01)水平及APACHEⅡ评分(均P＜0.01)显著高于无感染组(P＜0.05);感染组术后血清pro-ADM水平及APACHEⅡ评分随感染严重程度增加而升高(r=0.924),且各组之间差异具有统计学意义(P＜0.05),而各组IL-6及CRP水平差异无统计学意义.结论 (1)闭合性小肠破裂患者术前血清pro-ADM水平对预测患者术后继发腹腔感染有一定的预测价值.(2)患者术后血清pro-ADM水平对患者术后腹腔感染严重程度有一定的评估作用.

The value of serum pro-adrenomedullin for assessing prognosis of patients with closed rupture of small intestine

Objective To explore the relationship between preoperative serum pro-adrenomedullin (pro-ADM) in the patients with closed rupture of small intestine,and postoperative secondary abdominal infection,and to study the value of postoperative serum pro-ADM in assessment of severity of postoperative secondary abdominal infection of this patients.Methods Eighty-five patients with closed rupture of small intestine treated in the emergency surgery from June 2014 to May 2015 were selected.According to the presence of postoperative abdominal infection or not,these patients were divided into infection group and non-infection group.The infection group was further divided into SIRS,sepsis,severe sepsis,septic shock subgroups as per the severity of infection.The levels of serum pro-ADM,interleukin-6 (IL-6),C-reactive protein (CRP) were determined and the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was calculated at admission and the first day、the second day and the third day after operation.Comparisons of these biomarkers were carried out to find out the factors associated with postoperative abdominal infection.In addition,ROC curve was used to verify the factors for predicting the abdominal infection of these patients after operation.The relationship between serum levels of pro-ADM and APACHE Ⅱ score after operation was analyzed.The severity of abdominal infection after operation was assessed with laboratory findings.Results Compared with non-infection group,preoperative and postoperative serum pro-ADM (P =0.03,P ＜ 0.01),IL-6 (P =0.02,P ＜0.01) levels and APACHE Ⅱ scores (P ＜ 0.01,P ＜ 0.01) were significantly higher in infection group (P ＜ 0.05).In the infection groups,the postoperative levels of serum pro-ADM and APACHE Ⅱ scores were increased with the severity of infection increased (r =0.924),and the difference between the groups was statistically significant (P ＜ 0.05),but there were no significant differences in IL-6 and CRP levels between two groups.Conclusion (1) The serum levels of pro-ADM before operation has value in predicting the genesis of abdominal infection in these patients after operation.(2) The serum levels of pro-ADM after operation has value in severity assessment of abdominal infection in these patients after operation.