» arhiv
Možnosti:
[Prikaži v obliki za tiskanje]
[Naloga še ni vpisana v zbirko Cobiss]
ID naloge: 101 Letnik: 2001 Predmet: interna medicina
Pomen prokalcitonina kot oznacevalca okužbe pri akutnem
nekrozantnem pankreatitisu
Avtor: Gregor Hlebic
Mentor: Prof. dr. Saša Markovic, Doc. dr. Borjana Kremžar
IZHODIŠCE: Akutni pankreatitis (AP) je akutna vnetna bolezen trebušne slinavke, z razlicno prizadetostjo drugih regionalnih tkiv in oddaljenih organskih sistemov. Okoli 25% bolnikov razvije hujšo obliko AP z odpovedjo številnih drugih organov in lokalnimi zapleti. Smrtnost pri bolnikih z hudo potekajocim AP in odpovedjo organov je visoka, 30-50%.
NAMEN: Pri vodenju bolnikov z AP je nadvse pomembno zgodnje odkrivanje lokalnih in sistemskih zapletov. Zato se raziskovalci v zadnjih letih trudijo najti takšen kazalec, ki bi lahko že ob zacetku bolezni locil med blago obliko in hudo potekajocim AP in predvidel zaplete. Namen naše raziskave je bil dolociti mesto serumske koncentracije prokalcitonina (PCT), ki je že uveljavljen v diagnostiki okužbe, pri bolnikih z AP.
HIPOTEZA: Ocenjevali smo serumsko koncentracijo PCT pri bolnikih z AP, da bi preverili naslednje hipoteze: 1. PCT zgodnji napovedni dejavnik hudo potekajocega AP. 2. PCT je povezan z drugimi (že uveljavljenimi) napovednimi dejavniki (Ranson, APACHEII, CRP). 3. PCT je zgodnji oznacevalec okužbe pankreaticne nekroze. 4. Pri bolnikih z AP lahko PCT zgodaj napove razvoj organske odpovedi.
METODE: Pri vseh bolnikih z AP smo dolocali vrednost že ustaljenih krvnih parametrov in PCT vsakodnevno do cetrtega dne, kasneje pa ob poslabšanju klinicne slike in/ali klinicnih znakih okužbe. Vrednosti PCT smo primerjali med bolniki in z že uveljavljenimi napovednimi dejavniki (Ranson, APACHEII, CRP). Pri statisticni obdelavi podatkov smo uporabili enosmerno analizo variance in koeficient korelacije po Pearsonu.
REZULTATI: V naši prospektivni raziskavi smo zajeli 27 bolnikov, ki smo jih razdelili v tri skupine. 8 bolnikov (skupina 1) je imelo blago potekajoc AP, 13 (skupina 2) hudo potekajoc brez odpovedi organov, 6 (skupina 3) pa hudo potekajoc z organsko odpovedjo. 24 bolnikov je preživelo, 3 so umrli. Bolniki v skupini 2 in 3 so imeli znacilno višje vrednosti PCT, kot tisti iz skupine 1 (po 24h p=0,009 po 72h p=0,002). Ugotovili smo, da obstaja znacilna povezanost med Ransonovimi, APACHE II kazalci, CRP in PCT, vendar je bila senzitivnost in specificnost PCT višja (95%,88%). Bolniki z okuženo nekrozo niso imeli znacilno višje vrednosti PCT (po 24h p=0,07 po 72h p=0,186). Pri bolnikih, ki so kasneje razvili odpovedi organov pa so bile vrednosti PCT znacilno višje ( p=0,001 do p=0,031).
ZAKLJUCEK: V naši raziskavi se je PCT izkazal za najbolj senzitivnega in specificnega napovednega dejavnika hudo potekajocega akutnega pankreatitisa, ki že zelo zgodaj napoveduje razvoj zapletov, nismo pa potrdili domneve, da je zgodnji oznacevalec okužbe.
«»
[Abstract / English version]
Role of procalcitonin as an marker of infection in acute necrotizing pancreatitis
Author: Gregor Hlebic
Mentor: Prof. dr. Saša Markovic, Doc. dr. Borjana Kremžar
BACKGROUND: Acute pancreatitis (AP) is an acute inflammatory process of the pancreas, with variable involvement of other regional tissues or remote organ systems. About 25% of patients have a severe AP associated with organ failure and/or local complications. The mortality rate of patients with severe AP with complications remains between 30-50 %.
AIM: In the management of patients with severe AP, the most important diagnostic goal is identification of local and systemic complications. In last few years scientists try to find a marker, that could distinguish between mild and severe form of AP and predict complications in the early beginning of the disease. The aim of our study was to establish the place of serum concentration of procalcitonin (PCT), marker of infection, in clinical course of AP.
HYPOTHESIS: Our hypotheses were: 1.PCT is an early predictor of the severity of AP. 2.There is a correlation between PCT and other prognostic factors for the assessment of severity in AP. 3.PCT can differentiate between infected and sterile necrosis of pancreas. 4.PCTis an early predictor of development of organ failure.
METODS: As routinely, in all patients we measured blood levels of inflammatory markers and PCT daily up to fourth day of admission and later on, if clinical picture deteriorated and/or infection appeared. We compared PCT with other indicators of severity of acute pancreatitis such as Ranson, APACHE II criteria and C-reactive protein. For statistical processing of data we use one way analysis of variance and Pearson's correlation coefficient.
RESULTS: In our prospective study 27 patients with AP were included. According to our criteria 8 patients had mild AP (group 1), 13 patients (group 2) severe AP without organ failure and 6 patients (group 3) severe AP with organ failure. 24 patients survived, 3 died. Patients in group 2 and 3 had significantly higher level of PCT, than other in group 1. (24h after admission p=0,009; 72h after admission p=0,002). We found a correlation between Ranson, APACHE II criteria, C-reactive protein and PCT, but sensitivity and specificity of PCT were higher (95%,88%). Patients with infected necrosis didn't have significantly higher concentration of PCT (after 24h p=0,07, after 72h p=0,186), otherwise patients with organ failure had significantly higher concentrations in comparison to other without organ failure. (range from p=0,001 to p=0,031 ).
CONCLUSIONS: In our study PCT has a most sensitive and specific prognostic value in early distinguishing between mild and severe AP and in prediction of complications. But our results did not confirm, that PCT is a marker of infected pancreatic necrosis.
|
|
 |
Išči po nalogah
Brskaj po nalogah
|
