ABSTRACT
From June 2015 to June 2020, 52 patients who underwent emergency gastroscopy and treatment for upper gastrointestinal bleeding after percutaneous coronary intervention (PCI) at the Renmin Hospital of Wuhan University were included and retrospectively analyzed. The etiologic diagnosis of bleeding, results of hemostatic treatment and occurrence of complications during the emergency gastroscopy were observed. Among the 52 patients, 47 cases (90.4%) were found to have lesions that could explain upper gastrointestinal bleeding under emergency gastroscopy, and the remaining 5 cases (9.6%) could not clearly diagnose the cause of bleeding. Twenty-six cases (50.0%) were treated with emergency endoscopic hemostasis, of which 25 cases (96.2%) were successful. The median time for emergency endoscopy was 18 min. Seven cases (13.5%) had transient slowing of heart rate and lowering of blood pressure without serious complications. This shows that emergency gastroscopy is safe and effective in the diagnosis and treatment of upper gastrointestinal bleeding combined with post-PCI.
ABSTRACT
Objective To preliminarily investigate the clinical value of serum procalciton as a noninvasive marker in disease activity assessment in inflammatory bowel disease (IBD).Methods From January 2014 to June 2016,clinical data of 107 IBD patients were collected,including biological inflammatory parameters of peripheral blood such as serum procalcitonin levels,C-reactive protein (CRP) levels,erythrocyte sedimentation rate (ESR) and platelet count,clinical disease activity scores and endoscopic activity scores.The serum level of procalcitonin was measured using the traditional electrochemiluminescence immunoassay (ECL) method.The accuracy of diagnosis was analyzed by receiver operating characteristic (ROC) analysis.Kruskal-Wallis test and Spearman's rank correlation were performed for comparison between groups and correlation analysis.Results In the 60 patients with Crohn's disease (CD),the median serum level of procalcitonin of patients in active phase was higher than that of patients in remission phase (0.066 mg/L,0.047 mg/L to 0.168 rng/L vs 0.033 mg/L,0.024 mg/L to 0.044 mg/L),the median serum level of procalcitonin of patients in moderate to severe active phase was higher than that of patients in mild phase (0.112 mg/L,0.062 mg/L to 0.234 mg/L vs 0.046 mg/L,0.040 mg/L to 0.054 mg/L),and the differences were statistically significant (Z=4.883 and 3.326,both P＜0.01).There was a positive correlation between serum procalcitonin level and CRP,ESR,platelet count,plateletcrit,Crohn's disease activity index (CDAI) and Crohn's disease endoscopic index of severity (CDEIS) (r=0.494,0.387,0.339,0.328,0.736 and 0.689,all P＜0.05).The sensitivity and specificity of serum procalcitonin level ≥ 0.055 mg/L in predicting moderate to severe active CD were 85.0％ and 88.9％,respectively.The area under ROC curve (AUC) value of the combination of procalcitonin and CRP in diagnosing moderate to severe active CD was 0.905 (95 ％CI 0.827 to 0.982).In the 47 patients with ulcerative colitis (UC),the median serum procalcitonin level of patients in moderate to severe active phase was higher than those of patients in mild active phase and remission phase (0.059 mg/L,0.033 mg/L to 0.100 mg/L;0.030 mg/L,0.020 mg/L to 0.048 mg/L;0.030 mg/L,0.021 mg/L to 0.057 mg/L),and the differences were statistically significant (Z=2.056 and 2.783,P=0.040 and 0.005).Serum procalcitonin level was positively correlated with Mayo score,CRP level and Baron score (r=0.468,0.573 and 0.347,all P＜0.05).The specificity of serum procalcitonin level ≥0.065 mg/L in predicting moderate to severe active ulcerative colitis diagnosis was high but the sensitivity was low.Conclusion Serum procalcitonin may be of value in indicating the disease activity and severity.