目的 分析开放性胃肠手术患儿术后血清降钙素原(procalcitonin,PCT)、正五聚蛋白 3(pentraxin 3,PTX3)、高迁移率族蛋白 B1(high mobility group protein B1,HMGB-1)表达及其预测早期感染的价值.方法 2020年1月～2023年1月我院收治的开放性胃肠手术患儿206例,依据术后是否并发感染分为感染组(27例)和未感染组(179例).比较两组一般资料及围手术期指标,比较两组术前、术后1天、3天血清PCT、PTX3、HMGB-1水平;观察术后1天、3天各血清指标单一、联合检测对开放性胃肠手术患儿术后感染的预测价值;多因素Logistic回归分析术后感染的影响因素.结果 感染组术后1天、3天血清PCT、PTX3、HMGB-1水平分别为(2.42±0.39)pg/L、(3.74±0.53)μg/L,(2.07±0.66)μg/L、(3.06±0.75)μg/L,(18.35±2.74)μg/L、(26.09± 4.16)μg/L,均高于未感染组的(1.71±0.35)μg/L、(2.29±0.36)μg/L,(1.48±0.52)μg/L、(1.73±0.59)pg/L,(13.04±2.26)μg/L、(15.75±2.83)µg/L,两组比较差异有统计学意义(P＜0.05);绘制受试者工作特征(receiver operating characteristic,ROC)曲线显示,术后3天血清PCT、PTX3、HMGB-1联合检测预测开放性胃肠手术患儿术后感染的曲线下面积(Area under the curve,AUC)最大,为0.989;多因素Logistic回归分析显示,年龄为患儿术后感染的独立保护因素,术中出血量、手术时间、术后1天、3天血清PCT、PTX3、HMGB-1为独立危险因素(P＜0.05);感染组中重度感染患儿术后1天、3天血清PCT、PTX3、HMGB-1水平分别为(2.63±0.34)μg/L、(4.12± 0.56)μg/L、(2.31±0.69)μg/L、(3.39±0.81)μg/L、(19.86±2.91)μg/L、(28.84±4.40)μg/L,均高于轻度感染患儿的(2.11±0.28)μg/L、(3.19±0.49)µg/L、(1.72±0.60)μg/L、(2.58± 0.73)µg/L、(16.15±2.39)pg/L、(22.09±3.96)µg/L,差异有统计学意义(P＜0.05).结论 开放性胃肠手术患儿术后血清PCT、PTX3、HMGB-1表达显著增高,且其表达与术后早期感染及感染病情程度有关,三者联合预测价值更高.
The expression of serum procalcitonin,pentraxin 3 and high mobility group protein B1 in children after open gastrointestinal surgery and its value in predicting early infection
Objectiv To analyze the expression of serum procalcitonin(PCT),pentraxin 3(PTX3)and high mobility group protein B1(HMGB-1)in children after open gastrointestinal surgery and their application value in early infection prediction.Methods A retrospective analysis was performed on 206 children with open gastrointestinal surgery admitted to the hospital from January 2020 to January 2023.They were divided into infection group(27 case)and non-infection group(179 case)according to whether they had postoperative infection.The levels of serum PCT,PTX3 and HMGB-1 before operation,1 d and 3 d after operation were compared between the two groups.The predictive value of single and combined detection of serum indexes 1 d and 3 d after operation for postoperative infection in children with open gastrointestinal surgery was observed.The influencing factors of postoperative infection were analyzed by multivariate Logistic regression.Results The levels of serum PCT,PTX3 and HMGB-1 in the infection group were(2.42±0.39)µg/L,(3.74±0.53)pg/L,(2.07±0.66)p,g/L,(3.06±0.75)μg/L,(18.35±2.74)μg/L,and(26.09±4.16)μg/L at 1 d and 3 d after operation,which were higher than those in the non-infection group(1.71±0.35)pg/L,(2.29±0.36)µg/L,(1.48±0.52)µg/L,(1.73±0.59)pg/L,(13.04±2.26)μg/L,and(15.75±2.83)pg/L(P＜0.05).Receiver operating characteristic curve showed that the area under the curve(AUC)of combined detection of serum PCT,PTX3 and HMGB-1 in predicting postoperative infection in children with open gastrointestinal surgery was the largest(0.989)at 3 days after operation;Multivariate Logistic regression analysis showed that age was an independent protective factor for postoperative infection in children,and Intraoperative blood loss,operation time,serum PCT,PTX3 and HMGB-1 at 1 d and 3 d after operation were independent risk factors(P＜0.05);The levels of serum PCT,PTX3 and HMGB-1 in children with moderate to severe infection were(2.63±0.34)μg/L,(4.12±0.56)μg/L,(2.31±0.69)μg/L,(3.39±0.81)µg/L,(19.86 ±2.91)pg/L,and(28.84±4.40)μg/L at 1 d and 3 d after operation,which were higher than those in children with mild infection(2.11±0.28)μg/L,(3.19±0.49)µg/L,(1.72±0.60)µg/L,(2.58± 0.73)μg/L,(16.15±2.39)μg/L,and(22.09±3.96)pg/L(P＜0.05).Conclusion The expression of serum PCT,PTX3 and HMGB-1 in children after open gastrointestinal surgery was significantly increased,and its expression was related to early postoperative infection and the severity of infection,and the combined predictive value of the three was higher,which could provide reference for early infection prediction.
open gastrointestinal surgeryprocalcitoninpentraxin 3high mobility group protein B1infection
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