乳腺癌化疗导管相关性血流感染外周血TM和TF及CGRP水平变化

Changes of peripheral blood TM, TF and CGRP levels in patients with catheter-related bloodstream infection during breast cancer chemotherapy

目的探讨乳腺癌化疗患者外周血血栓调节蛋白(TM)、组织因子(TF)、降钙基因相关肽(CGRP)对导管相关性血流感染(CRBSI)的诊断价值,并分析与感染程度相关性。方法选取2017年6月-2019年12月南通大学附属医院475例乳腺癌患者作为研究对象,其中62例并发CRBSI作为CRBSI组,413例未并发CRBSI作为N-CRBSI组。比较两组外周血TM、TF、CGRP水平,采用Logistic回归分析乳腺癌患者化疗后CRBSI影响因素,采用受试者工作特征曲线(ROC)分析外周血TM、TF、CGRP水平对乳腺癌患者化疗后CRBSI的诊断价值,分析不同感染程度外周血TM、TF、CGRP水平,采用Pearson分析外周血TM、TF、CGRP水平与感染程度相关性。结果年龄、导管留置时间、导管维护周期、导管移动、导管材料、肠外输注营养、合并基础疾病及外周血TM、TF、CGRP水平均为乳腺癌患者化疗后CRBSI发病影响因素(P<0.05);TM、TF、CGRP联合诊断乳腺癌患者化疗后CRBSI的曲线下面积(AUC)为0.897,敏感度达98.39%、特异度达70.98%,高于任一单一指标(P<0.05);乳腺癌化疗后CRBSI不同感染程度患者外周血TM、TF、CGRP水平相比,差异有统计学意义(P<0.05),外周血TM、TF水平与感染程度呈正相关,CGRP水平与感染程度呈负相关(P<0.05)。结论TM、TF、CGRP对乳腺癌患者化疗后CRBSI均具有诊断价值,TM、TF、CGRP水平同CRBSI感染程度密切相关,对临床判断乳腺癌化疗后CRBSI患者病情程度及预后具有指导意义。

OBJECTIVE To investigate the diagnostic value of peripheral blood thrombomodulin(TM),tissue factor(TF)and calcitonin gene-related peptide(CGRP)in breast cancer patients undergoing chemotherapy for catheter-related bloodstream infection(CRBSI),and to analyze the correlation with the degree of infection.METHODS A total of 475 breast cancer patients in Affiliated Hospital of Nantong University from Jun 2017 to Dec 2019 were recruited in the study.Among them,62 cases with CRBSI were divided into the CRBSI group,and 413 cases without CRBSI were in the N-CRBSI group.The peripheral blood levels of TM,TF,and CGRP were compared between the two groups.Multivariate Logistic regression analysis was used to analyze the influencing factors for CRBSI in breast cancer patients after chemotherapy.The receiver operating characteristic curve(ROC)was used to analyze the diagnostic value of peripheral blood TM,TF,and CGRP levels for CRBSI after chemotherapy in breast cancer patients.The levels of TM,TF,and CGRP in peripheral blood of patients with different degrees of infection were analyzed.Pearson analysis was used to analyze the correlation between the levels of TM,TF,and CGRP in peripheral blood and the degree of infection.RESULTS Age,catheter indwelling time,catheter maintenance cycle,catheter movement,catheter material,parenteral nutrition,combined with underlying diseases and peripheral blood TM,TF,CGRP levels were all factors influencing the incidence of CRBSI after chemotherapy in breast cancer patients(P<0.05).The AUC of the combination of of TM,TF,and CGRP in the diagnosis of CRBSI in breast cancer patients after chemotherapy was 0.897,with a sensitivity of 98.39%and a specificity of 70.98%,which was significantly higher than those of any single index(P<0.05).There were significant differences in the levels of TM,TF,and CGRP in the peripheral blood of patients with different degrees of CRBSI infection after breast cancer chemotherapy(P<0.05).Peripheral blood TM and TF levels were positively correlated with the severity of infection,and CGRP levels were negatively correlated with the severity of infection(P<0.05).CONCLUSION Indexes of TM,TF,and CGRP have diagnostic value for CRBSI in breast cancer patients after chemotherapy.The levels of TM,TF,and CGRP are closely related to the degree of CRBSI infection,which can have guiding significance for clinical prediction of the severity and prognosis of CRBSI patients after breast cancer chemotherapy.