目的    探讨动态监测降钙素原（PCT）在肠瘘病人行确定性手术后手术部位感染（SSI）中的预测价值。方法    回顾性分析2012年2月至2013年10月南京军区南京总医院肠瘘治疗中心收治的行确定性手术治疗的62例肠瘘病人临床资料，根据术后是否出现SSI将病人分为感染组（22例）及对照组（40例）。术前及术后第1、3、5、7天分别采集静脉血检测血清PCT、C反应蛋白（CRP）和WBC计数，评价PCT与术后SSI的关系。结果    临床诊断SSI的时间平均为术后6.1 d。感染组术后第3、5天的血清PCT质量浓度明显高于对照组（P<0.05）；感染组术后第7天CRP质量浓度高于对照组（P<0.05）；感染组术后第5、7天WBC计数高于对照组（P<0.05）。ROC曲线分析显示，术后第3天PCT>0.97 μg/L对预测SSI的发生具有显著价值（曲线下面积=0.83，灵敏度77.3%，特异度87.5%）。多元回归分析显示，术后第3天PCT>0.97 μg/L是预测术后SSI的独立因素（OR=27.76，95%CI=6.17～124.90，P<0.001）。结论  PCT的动态变化对预测肠瘘病人确定性手术后SSI的发生有一定的价值。

Predictive value of procalcitonin for postoperative surgical site infection after definitive operation of intestinal fistula        REN Hua-jian，LI Guan-wei，WANG Ge-fei，et al. Research Institute of General Surgery，Nanjing General Hospital of Nanjing Military Command，PLA, Nanjing 210002，China
Corresponding author：REN Jian-an，E-mail：jan@medmail.com.cn
Abstract    Objective    To explore the predictive value of dynamic testing procalcitonin (PCT) in postoperative surgical site infection (SSI) after definitive operation of intestinal fistula. Methods    Definitive reconstruction operation of digestive tract was performed in 62 patients with intestinal fistula between February 2012 and October 2013 in Nanjing General Hospital of Nanjing Military Command. Patients with and without SSI were classified as infection group (22 cases) and normal group (40 group). PCT level，C-reactive protein level and white blood cell count were assessed preoperatively and on the 1st，3rd，5th and 7th day postoperatively. The relationship between PCT value and SSI after operation was evaluated. Results    The median time when SSIs were diagnosed clinically was 6.1 days after surgery. PCT values in infection group were signi?cantly higher than those in normal group on postoperative 3rd and 5th day (P<0.05). C-reactive protein levels on postoperative 7th day in infection group were higher than those in normal group (P<0.05). White blood cell counts on postoperative 5th, 7th day in infection group were higher than those in normal group (P<0.05). Receiver-operating characteristics demonstrated that PCT had the highest diagnostic accuracy with a value more than 0.97 μg/L on postoperative 3rd day. The area under the curve (AUC) of PCT for SSI was 0.83 with 77.3% sensitivity and 87.5% specificity. In a multivariate logistic regression analysis，PCT level more than 0.97 μg/L on postoperative 3rd day was a signi?cant predictor for postoperative SSI on with an odds ratio of 27.76 (95% CI=6.17～124.90，P<0.001). Conclusion    The dynamic change of PCT is valuable to predict the occurrence of SSI after definitive operation of intestinal fistula.