目的

探讨降钙素原（PCT）在老年急性胆囊炎严重程度评估中的预测价值。

方法

回顾性分析2013年7月至2023年8月在国家电网公司北京电力医院行胆囊切除术的243例老年急性胆囊炎患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男111例，女132例；年龄60～92 岁，中位年龄68岁。根据东京指南（2018）将患者分为急性轻中度胆囊炎（AMC）组和急性重度胆囊炎（ASC）组。ASC预测单因素分析采用秩和检验和χ²检验，多因素分析采用Logistic多因素回归分析。绘制ROC曲线，通过ROC曲线确定PCT、WBC和高敏C-反应蛋白（Hs-CRP）最佳界值，并计算曲线下面积（AUC）。

结果

Logistic多因素回归分析显示，胆囊周围或肝周积液（OR=0.258，95%CI：0.102～0.651）、WBC（OR=1.262，95%CI：1.072～1.486）、Hs-CPR（OR=1.020，95%CI：1.012～1.028）、PCT（OR=0.712，95%CI：0.559～0.906）是老年ASC的独立预测因素（P＜0.05）。ROC曲线分析显示，肝周或胆囊周围积液诊断老年ASC发生的AUC为0.694（95%CI：0.619～0.769）；PCT、WBC和Hs-CRP诊断老年ASC发生的AUC分别为0.835（95%CI：0.784～0.886）、0.875（95%CI：0.827～0.924）和0.876（95%CI：0.828～0.925），最佳界值分别为0.50 μg/L、10.9×10⁹/L和 66.2 mg/L；PCT的敏感度及特异度分别为0.89和0.77。四者联合诊断曲线的AUC为0.914，高于单一PCT、Hs-CRP、WBC和胆囊周围或肝周积液的AUC。

结论

PCT对老年 ASC具有良好的诊断效能，联合WBC、Hs-CPR和胆囊周围或肝周积液检测的预测效能更高、评判效果更可靠。

Objective

To evaluate the value of procalcitonin （PCT） in predicting the severity of acute cholecystitis in elderly patients.

Methods

Clinical data of 243 elderly patients with acute cholecystitis who underwent cholecystectomy in Beijing Electric Power Hospital of State Grid Corporation of China from July 2013 to August 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them，111 patients were male and 132 female，aged 60-92 years，with a median age of 68 years. According to the Tokyo Guidelines （2018），all patients were divided into acute mild and moderate cholecystitis （AMC） group and acute severe cholecystitis（ASC） group. Univariate analysis of ASC prediction was conducted by rank-sum test and Chi-square test.Multivariate analysis was performed by multivariate Logistic regression analysis. The receiver operating characteristic （ROC） curve was delineated to determine the optimal threshold values of PCT，WBC and high-sensitivity C-reactive protein （Hs-CRP）. The area under the ROC curve （AUC） was calculated.

Results

Multivariate Logistic regression analysis showed that perigallbladder or perihepatic effusion（OR=0.258，95%CI: 0.102-0.651），WBC （OR=1.262，95%CI: 1.072-1.486），Hs-CPR （OR=1.020，95%CI:1.012-1.028） and PCT （OR=0.712，5%CI: 0.559-0.906） were the independent predictive factors for ASC in elderly patients （P＜0.05）. ROC curve analysis showed that the AUC of perihepatic or perigallbladder effusion in the diagnosis of ASC in elderly patients was 0.694 （95%CI: 0.619-0.769）. The AUC of PCT，WBC and Hs-CRP in the diagnosis of ASC in elderly patients was 0.835 （95%CI: 0.784-0.886），0.875（95%CI: 0.827-0.924） and 0.876 （95%CI: 0.828-0.925），respectively. The optimal threshold values were 0.50 μg/L，10.9×10⁹/L and 66.2 mg/L，respectively. The sensitivity and specificity of PCT were 0.89 and 0.77，respectively. The AUC of these 4 parameters combined in the diagnosis of ASC in elderly patients was 0.914，higher than that of PCT，Hs-CRP，WBC and perigallbladder or perihepatic effusion alone.

Conclusions

PCT yields high diagnostic efficacy for ASC in the elderly patients. PCT combined with WBC，Hs-CPR and perigallbladder or perihepatic effusion possesses higher predictive efficacy and more reliable evaluation effect.