血清降钙素原(PCT)鉴别肿瘤患者发热原因的价值探讨

The Value of Serum Procalcitonin in the Differentiation of the Cause of Fever in Patients with Malignant Diseases

目的探讨血清PCT检测对鉴别肿瘤患者发热原因的意义。方法回顾性分析170例恶性肿瘤伴发热患者PCT水平与发热原因的关系。结果败血症组血清PCT检测阳性率为93.75%,普通感染组阳性率为70.48%,肿瘤热组阳性率为6.06%,两两比较,均有显著性差异(P=0.00001)。按感染病原体分析发现,无论是细菌感染、真菌感染还是细菌混合真菌感染,其PCT水平均明显高于肿瘤热组(P<0.05),但细菌、真菌、细菌混合真菌感染3组两两比较,PCT值均无显著性差异。PCT诊断败血症的灵敏度为87.50%,特异度为70.32%,阳性预测值和阴性预测值分别为23.33%和98.19%。结论合并感染特别是合并败血症的肿瘤患者PCT水平明显升高,肿瘤相关性发热患者PCT水平正常,初步认为PCT水平的检测可鉴别肿瘤患者的发热原因,为恰当的抗感染或抗肿瘤治疗提供实验依据,从而更好更早地指导临床治疗。

Objective To evaluate the value of serum procalcitonin analysis in the differentiation of the cause of fever in patients with malignant diseases. Methods The relationship between the serum PCT levels and the causes of fever in 170 patients with malignant tumors was retrospectively analyzed. Results The positive rates of serum procalcitonin in patients with septicemia, common infection and tumor related fever were 93.75% , 70.48% and 6.06%, which was significantly different （P = 0. 00001 ）. Serum procalcitonin levels were significantly higher in the patients with bacteria infection, fungus infection and bacteria complicated with fungus infection than that in the patients with tumor related fever （P 〈 0.05）, but the serum procalcitonin leves in the patients with bacteria infection, fungus infection and bacteria complicated with fungus infection were not significantly different. The sensitivity, specificity, positive predictive value and negative value of serum procalcitonin test in the diagnosis of septice- mia were 87.50% ,70.32% ,23.33% and 98.19%. Conclusion Patients with malignant tumors complicated with infection have significantly elevated serum PCT levels ; whereas patients with tumor related fever have normal PCT levels. Analysis of serum procalcitonin might be used in the differentiation of the cause of fever in patients with malignant tumors.