摘要: |
目的 探讨前蛋白转化酶枯草溶菌素9(proprotein convertase subtilisin/kexin type 9,PCSK9)作为食管病变内镜下黏膜下剥离术(endoscopic submucosal dissection,ESD)术后早期感染预测指标的价值。方法 纳入2017年3月至2017年10月复旦大学附属中山医院收治的65例浅表肿物行食管ESD患者。术后监测患者体温,定义体温≥37.5℃为ESD后发热,对体温≥38℃的患者进行血培养。同时检测患者血液中的PCSK9、脂多糖(lipopolysaccharide,LPS)和其他标志物如白细胞计数(white blood cell,WBC)、C-反应蛋白(C-reaction protein,CRP)和白介素6(interleukin 6,IL-6)等。结果 37例患者出现发热,其中12例患者接受血培养,其中1例显示阳性结果。血PCSK9、LPS、WBC、CRP和IL-6均在发热组增加;与37.5℃≤体温<38℃的患者相比,在体温≥38℃的患者中,只有PCSK9和IL-6显著增加。体温≥38℃的患者PCSK9平均水平为(355.29±56.17) ng/mL,而37.5℃≤体温<38℃患者的平均PCSK9水平为(304.19±60.91)ng/mL(P=0.020)。在体温≥38℃的患者中,血PCSK9和LPS水平正相关(r=0.720,P=0.011)。结论 PCSK9可作为食管ESD患者术后感染的早期敏感生物标志物。 |
关键词: 前蛋白转化酶枯草溶菌素9 内镜下黏膜下剥离术 食管病变 感染 |
DOI:10.12025/j.issn.1008-6358.2022.20220016 |
分类号:R571 |
基金项目:国家自然科学基金(82000575),上海市科学技术委员会科研计划项目(19ZR1409400). |
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Serum proprotein convertase subtilisin/kexin type 9 as a new marker in evaluating the infectious status of patients after endoscopic submucosal dissection for esophageal neoplasm |
ZOU Yan-ting1, NING Liu-xin1, MA Li-li2, CAI Yu1, ZHANG Shun-cai1, XU Bei-li1
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1.Department of Gastroenterology & Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China;2.Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Abstract: |
Objective To explore the value of proprotein convertase subtilisin/kexin type 9 (PCSK9) as a predictor of early infectious status after endoscopic submucosal dissection (ESD) for esophageal neoplasm. Methods A total of 65 patients who had undergone esophageal ESD for superficial neoplasm in Zhongshan Hospital, Fudan University from March to October 2017 were enrolled. Their body temperature (BT) was monitored and post-ESD fever was defined as BT ≥ 37.5℃. Blood culture was taken in the patients who had BT ≥ 38℃. An investigation was made of PCSK9, lipopolysaccharide (LPS) and other markers such as white blood cell (WBC), C-reaction protein (CRP) and interlukin-6 (IL-6). Results It was found that 37/65 patients developed a fever, and 12/37 received blood culture, with one showing a positive result. Serum PCSK9, LPS, WBC, CRP and IL-6 all increased in the fever cohort; however, only PCSK9 and IL-6 increased significantly in those who had BT ≥ 38℃ when compared with those who had 37.5℃ ≤ BT <38℃. The mean levels of PCSK9 were (355.29±56.17) ng/mL in the patients of BT ≥ 38℃, versus (304.19±60.91) ng/mL in the patients of 37.5℃ ≤ BT<38℃ (P=0.020). A positive correlation plus a linear regression relationship was observed between the levels of serum PCSK9 and LPS in those who had BT ≥ 38℃ (r=0.720; P=0.011). Conclusions PCSK9 could serve as an early and sensitive biomarker in detecting the infectious status of a patient during the perioperative period of esophageal ESD. |
Key words: proprotein convertase subtilisin/kexin type 9 endoscopic submucosal dissection esophageal neoplasm infectious |