降钙素原在恶性血液病发热中的诊断价值

Procalcitonin in the differential diagnosis of the fever in hematological malignancies

目的:探讨血清降钙素原(Procalcitonin,PCT)在恶性血液病发热中对于感染的诊断价值。方法:分析我科自2006年5月～2007年5月收治的85例恶性血液病患者105次发热病程中的PCT和C反应蛋白(C-reactive protein,CRP)浓度特征,根据患者临床特征将其分为败血症组、病原学证明肺炎组、临床证明肺炎组、病原学证明感染组、临床证明感染组、非感染性发热组和不明原因发热组,将各组PCT和CRP平均浓度进行比较,并进行ROC曲线检验;对伴并发症和不伴并发症热程以及死亡和存活的热程中患者的PCT和CRP浓度进行比较,并行ROC曲线检验。结果:105例次热程中感染组84例次(80.0%),其中败血症组8例次(12.4%)。发热组PCT和CRP浓度显著高于不发热组(P<0.001)。感染组PCT浓度显著高于非感染组和不明原因发热组(P<0.001),PCT对于感染的最佳鉴别界值为0.157μg/L;感染组CRP浓度与非感染组有显著差异(P=0.047),但对于感染与非感染发热鉴别价值不大。败血症热程中患者的PCT和CRP浓度显著高于非败血症热程(P<0.001),PCT和CRP对于败血症热程均有较好的鉴别价值,最佳鉴别界值分别为1.009μg/L和85.5mg/L。结论:PCT血清浓度与恶性血液病发热患者的感染严重程度相关,尤其对于败血症特异性高。对于该群患者感染性发热和非感染性发热、败血症发热和非败血症发热有很好鉴别价值。CRP血清浓度对于该群患者感染性发热与非感染发热无鉴别意义,但对于败血症发热与非败血症发热有较好的鉴别价值。

Objective ：To investigate whether serum procalictonin （PCT） levels could be useful to differentiate different infection degree of malignant hematological disease. Methods ：PCT and C-reactive protein （CRP） serum concentration were determined about 24 hours after the onset of febrile period in the 105 cases febrile periods of 85 patients with malignant hematological disease who were in our hospital from May 2006 to May 2007. The febrile periods are divided into different groups （ septicemia group, mierobiologieally documented pneumonia group, clinically documented pneumonia group, microbiologically documented regional infection group, clinically documented regional infection group, uninfection group and fever of unknown origin group） according to causes of fever. Results：There were 84 cases infection periods in the 105 cases febrile periods. The septicemia group had 8 cases. PCT and CRP serum concentrations of fever group were significantly higher than the group without fever（P 〈0. 001 ）. The PCT serum concentration of infection group was higher than the uninfection and FUO group（ P 〈0. 001 ）. The optimal cutoff point of PCT for differentiating the infection fever and the uninfection fever was 0. 157ug/L. The CRP serum concentrations of infection group is slightly higher than the uninfeetion group（P =0. 047）. And the CRP was not a good indicator in differentiating the infection fever and the uninfection fever. The PCT and CRP serum concentrations of septicemia fever were notably higher than the fever which is not caused by septicemia（ P 〈0. 001 ）. The optimal cutoff points of PCT and CRP were 1. 009ug/L and 85.5mg/L, respectively, which had good differentiating value for septicemia. Conclusion： The PCT serum concentration was correlated with the infection degree of patients with malignant hematological disease. And it has high specificity in the diagnosis of septicemia. It can be served as an useful marker for the differentiation of infection febrile periods and noninfecction febrile periods as well as the septicemia febrile periods and the febrile periods without septicemia.