肝移植术后血清降钙素原监测的临床意义

目的 探讨血清降钙紊原(PCT)浓度在肝移植术后的变化规律以及对细菌感染、病毒感染和排斥反应的诊断与鉴别诊断意义.方法 采用荧光免疫夹心法检测25例肝移植术后病人的血清PCT浓度,并根据术后并发症种类分为无并发症组、病毒感染组、急性排斥反应组和细菌感染组.结果 肝移植术后各组第1～3天的平均PCT浓度分别为(24.50±4.6)ng/ml、(21.40±3.3)ng/ml、(12.25±3.1)ng/ml,呈逐渐下降趋势;肝移植术后无并发症组、病毒感染组和急性排斥反应组的平均PCT浓度在7～10 d后下降至近于正常,并维持在(0.51±0.11)ng/ml;而且病毒感染组和急性排斥反应组,在发热初期以至诊疗结束平均PCT浓度分别为(0.44±0.16)ng/ml、(0.53±0.14)ng/ml,未见升高;而细菌感染组的PCT浓度为(15.70±5.1)ng/ml,在发热初期即明显高于前3组(P<0.05);在无并发症组、病毒感染组、急性排斥反应组之间差异无统计学意义(P>0.05).结论 肝移植术后第1～3天,血清PCT呈现高值,随后逐渐下降,7～10 d后降至近于正常;血清PCT在病毒感染和排斥反应期间不升高,而在细菌感染时显著升高,因此血清PCT监测有助于肝移植术后细菌感染与排斥反应或病毒感染的鉴别诊断.

Clinical significance of monitoring procalcitonin in patients after liver transplantation

Objective To investigate the changes of procalcitonin (PCT) in patients after liver transplantation and explore their significance for diagnosis and differential diagnosis among bacterial infection, viral infection and acute rejection.Methods PCT was measured in serum of 25 liver trans-plant patients by immunofluorescence sandwich method and the patients were divided into the non-complication group, viral infection group, acute rejection group and bacterial infection group.Results The concentrations of PCT in the 1st, 2nd and 3rd day after transplantation were(24.50 ± 4.6)ng/ml, (21.40± 3.3)ng/ml and (12.25 ± 3.1)ng/ml, respectively and they presented a decreasing tendency.The concentrations of PCT in non-complication group, viral infection group and acute rejection group decreased gradually and were near the normal level of (0.51±0.11) ng/ml after 7～10 days.Moreo-ver, the concentrations of PCT in viral infection group and acute rejection group were (0.44 ± 0.16)ng/ml and(0.53±0.14)ng/ml when the patients were in fever.The concentration of PCT in the viral infection group were(15.70±5.1)ng/ml, which was significantly higher than that in other 3 groups (P<0.05) in the early days of fever.The statistical differences among the other three groups were not significant (P>0.05).Conclusion The concentration of PCT in serum is high in the 1st, 2nd and 3rd day then decreased gradually soon.The concentration of PCT is not high in viral infection or acute rejection while significantly high in bacterial infection, so it can be used to differentiate the bacterial infection from acute rejection and virus infection after liver transplantation.