| [Background]Biliary infection (biliary tract infection, BTI) is the most common complications of bile duct stones, bile duct cancer and other bile duct diseases, and also it’s one of the most important causes of the systemic inflammatory response syndrome (SIRS) and sepsis, multiple organ dysfunction (MODS) and mortality in patients. Accordingly, if not early diagnosis and treatment, better person adds physical pain to patients and economic loss, serious it will cause life-threatening.No cholangitis patients with biliary obstruction, however, by physical examination, routine blood and imaging examination it is difficult to diagnose the presence of biliary tract infection.And intraoperative bile culture results at least need 24 to 48 hours, during this period, if only use of antibiotics according to experience, it will lead to no infection in patients with medical expenses increased, and the increase of resistant strains. However if not timely use of antibiotics it will lead to the course of infection patients in increase even further.So, if you can find a reliable indicator of early diagnosis of biliary tract bacterial infections, and it is necessary if it can be used to guide the rational use of antimicrobial drugs in the clinical medical treatment. Procalcitonin (PCT) is composed of 116 amino acids, the precursor of calcitonin hormone is mainly composed of medulla cells of the thyroid gland secretion in a healthy person’s blood, the concentration of serum PCT is extremely low (< 0.1 ng/ml), and in the bacterial infection PTC serum levels rise rapidly, and high sensitivity and specificity for bacterial infections has as one of the indicators monitoring infection in recent years, it has been in many disciplines of procalcitonin the correlation between the original and infectious disease research, and obtain the reliable conclusion in, but whether it can be used as early biliary infection monitoring indicators, whether on the early diagnosis of biliary tract infection has clinical value, It rarely be reported at home and abroad.[Objective] 1. By measuring serum procalcitonin(PCT) hospitalized patients with biliary obstruction, C-reactive protein (CRP) and white blood cell count (WBC), discussing its value to the diagnosis of biliary obstruction in patients with biliary bacteria infection, we diagnose the condition of the patients as early as possible, and it also provide reference for the selection of treatment options.2. Studyingwhether there is a correlation between the PCT and the types of pathogenic microorganism, discussing its ability to identify bacteria for which one (G-) bacteria, G+ bacteria, anaerobic bacteria cause the infection.3. By evaluating of procalcitonin (PCT) antibacterial drug use to guide the optimization of antimicrobial therapy in patients with biliary obstruction, to assess the serum PCT level can become a kind of simple and effective guide the rational use of antimicrobial agents in patients with biliary obstruction laboratory indicators.[Method] 1. This study will be brought into the department of organ transplantation of our hospital during September 2012 and February 2012 and surgery treatment (including open surgery and interventional surgery) of 202 patients with adult will be put into research.2. This research is divided into two parts:the first part, selecting 105 patients during September 2012-February 2012 to the experimental study of with biliary obstruction, each selected patients were recorded age and gender.Lab data collection including PCT, CRP, WBC count, total bilirubin, bile microorganism culture results.In bile culture positive for biliary infection diagnostic criteria, compare the PCT, CRP, WBC sensitivity and specific degrees of biliary tract bacterial infections.The second part, selecting a total of 97 patientsin March 2014 February 2015 in hospital, with biliary obstruction.Randomly divided into 2 groups (PCT group and Control group), on admission of PCT and CRP, WBC.PCT PCT value in the diagnosis of the first part of study group best cutting value as an index of antibiotic use in patients with biliary tract infection, controlled way according to the CRP, WBC, body temperature, clinical manifestations and other traditional evaluation standard use of antibiotics, respectively to compare two groups patients after admission temperature changes, clinical manifestation, bile culture conditions.About the termination or continue to use antimicrobial drugs, PCT group two day (i.e.,1,3, 5,7...) in venous blood detection of PCT levels, according to the PCT level decision;Control group by clinical physicians according to patients’ symptoms, signs, laboratory examination and other guide decision, without reference to PCT values.Antibacterial drug usage record and compare the 2 groups of patients, antimicrobial drug use time, length of hospital stay, mortality rate, clinical cure rate.[Results] 1. In the early diagnosis on biliary tract bacterial infections, bile culture positive group and negative group patients between the WBC no statistical difference (P> 0.05), and of bile cultures of PCT and CRP positive group was obviously higher than that of negative group (P< 0.05), we think of PCT and CRP in patients with early diagnosis of biliary obstructive biliary infection has practical significance.The sensitivity of PCT and CRP were 91.4%,85.4%;92.9%,71.4%; Positive predictive value was 91.6%,70.6%;Negative predictive value was 92.8% and 84.7%.Subjects features work curve drawing, PCT, CRP, WBC count of the area under the ROC curve (AUC) were 0.951,0.840,0.578, PCT of the area under the ROC curve (0.951), the largest in PCT in the early diagnosis of biliary infection is superior to CRP, WBC (P< 0.05).2. In terms of identification of pathogenic microorganisms, G-bacteria, G +bacteria were 0.42±0.35 PCT concentration ug/L,0.47±0.40 ug/L, compare the differences between both no statistical significance.(3) PCT group than the control group can be more early, more accurate guidance of early biliary infection, the rational use of antimicrobial drugs, in addition, two groups of patients duration of antimicrobial drug use were 7.24±5.63 and 11.50±7.52d, length of hospital stay were 10.32±4.41 and 14.36±6.25d, have significant difference (P< 0.05), shortened the PCT group of antimicrobial drug use time and hospitalization days, and the antibacterial drug utilization rate, mortality, and there was no statistically significant difference in clinical cure rate.[Conclusion](l)The PCT can be used as biliary obstruction in patients with early inflammatory indexes of biliary infection, and it has a better sensitivity or specific degrees than CRP.(2) PCT in biliary tract infection in the early cannot differentiate between infection is by what kind of pathogenic microorganisms (G-bacteria, G+bacteria).(3) PCT can guide the proper use of antibacterials of biliary infectionmore early and accurately. |
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