目的：探讨血清降钙素原（PCT）与C 反应蛋（CRP）水平在反流性胆管炎的临床诊疗价值。方法：回顾性分析2010 年1 月—2014 年6 月收治的40 例反流性胆管炎的患者资料，患者治疗前均行血培养、胆汁细菌培养检查，并检测治疗前及治疗后4 d 血清PCT、CRP 及血白细胞（WBC）值；比较各项指标治疗前的检测阳性率的差异以及PCT、CRP 和WBC 值治疗前后的变化，根据患者感染是否控制分组，用受试者工作特征曲线（ROC）分析PCT、CRP 和WBC 治疗后/ 治疗前比值与感染是否控制的关系。结果： 治疗前PCT、CRP、WBC、血培养、胆汁培养阳性检测率分别为92.5%、87.5%、57.5%、25.0%、100.0%，PCT 与CRP 的阳性率差异无统计学意义（P=0.709），但均明显高于WBC 和血培养（均P<0.05）；与治疗前比较，治疗后血清PCT、CPR 值均明显降低（均P<0.05），但血WBC 水平变化不明显（P>0.05）；PCT 比值对感染控制的判断ROC 曲线下面积为0.827（95% CI=0.724~0.929，P<0.001)，灵敏度为87.5%，特异度为77.5%，CPR 为0.764（95% CI=0.644~0.883，P<0.001），灵敏度为92.5%，特异度为60.5%，而WBC 比值差异无统计学意义（P>0.05）。结论：血清PCT、CRP 水平是诊断反流性胆管炎的敏感指标，两者的变化对判断反流性胆管炎患者感染是否得到有效控制起到重要的参考价值。
Clinical diagnostic value of serum procalcitonin and C-reactive protein in reflux cholangitis
Objective: To investigate the clinical diagnostic value of serum procalcitonin (PCT) and C-reactive protein (CRP) levels in reflux cholangitis. Methods: The clinical data of 40 patients with reflux cholangitis treated during January 2010 to June 2014 were retrospectively analyzed. In all patients, blood culture and bile bacterial culture were performed before treatment, and the serum PCT and CRP as well as white blood cells (WBC) were measured before and 4 d after therapy. The difference in positive detection rate among all parameters before treatment, and the pre- and post-treatment changes in levels of PCT, CRP and WBC were compared; patients were grouped according to whether their infection was controlled or not, and then the relations of whether the infection controlled or not with the post- to pretreatment ratios of PCT, CRP and WBC were determined by using receiver operating characteristic curve (ROC) analysis. Results: Before treatment, the positive detection rate of PCT, CRP, WBC, blood culture and bile bacterial culture was 92.5%, 87.5%, 57.5%, 25.0% and 100.0% respectively, and the positive detection rates of PCT and CRP had no significant difference (P=0.709), but both were significantly higher than that of WBC or blood culture (all P<0.05). Compared with pretreatment value, either PCT or CRP level was significantly reduced (both P<0.05), but the WBC had no significant change (P>0.05), the area under ROC in estimating infection control or not for PCT ratio was 0.827 (95% CI=0.724–0.929, P<0.001), with a sensitivity of 87.5% and specificity of 77.5%, and for CRP ratio was 0.764 (95% CI=0.644–0.883, P<0.001), with a sensitivity of 92.5% and specificity of 60.5%, but which for WBC ratio showed no significant difference (P>0.05). Conclusion: Serum PCT and CRP levels are sensitive indicators for diagnosis of reflux cholangitis, and their alterations have an important reference value for estimating whether the infection is controlled or uncontrolled.