儿童造血干细胞移植抗胸腺细胞球蛋白预处理期间降钙素原和C反应蛋白的变化

Procalcitonin and C-reactive protein changes during pretreatment of anti-thymocyte globulin before hematopoietic stem cell transplantation in pediatric patients

目的探讨重型β-地中海贫血儿童异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)预处理期间使用抗胸腺细胞球蛋白(anti-thymocyte globulin,ATG)后降钙素原(procal-citonin,PCT)及C反应蛋白(C-reactive protein,CRP)升高的临床价值。方法 25例重型β-地中海贫血患儿纳入本前瞻性研究组,allo-HSCT前予以ATG预处理,使用前监测体温、PCT、CRP、肝功能及血常规,以后每天监测CRP及血常规,隔天监测PCT及肝功能,至少持续1周。结果 ATG使用前,PCT、CRP、体温等均在正常范围内;第1天PCT、CRP及体温较基础水平显著增高(P<0.01),其后持续下降,平均4～6d降至正常水平。移植前血清铁蛋白水平及肝功能优劣与CRP及PCT变化无显著相关性(P>0.05)。结论使用ATG会引发发热反应,同时炎症指标PCT、CRP快速增高。ATG使用期间的CRP及PCT这些常用的炎症指标的升高不能说明存在感染,对判断有无感染价值有限。PCT及CRP升高与使用ATG前的肝功能、血清铁蛋白、白细胞水平等无显著相关。

Objective To monitor the inflammatory marks of Procalcitonin （PCT） and C-reaction （CRP） in peadiatric patients with major β-thalassaemia scheduled for allogenetic hemopoietic stem cell transplantation during conditioning with anti-thymocyte globulin （ATG）.Methods Twenty-five children with majorβ-thalassaemia were enrolled.ATG was administrated for conditioning before transplantation.Baseline PCT,CRP,white blood cell count,liver function and serum ferroprotein were assessed before conditioning.CRP and white blood cell count were assessed daily,while PCT and liver function were assessed alternate days for one week.Results Baseline levels （BL） of both PCT and CRP before ATG administration were within normal range （PCT0.5 ug/L,CRP5 mg/L）.Significant increase of PCT and CRP was observed on 1st day （P0.01） and regressed to baseline level between 4th and 6th day.No significant correlation between PCT or CRP level and liver functions or serum ferritin levels （P0.05）.Conclusion ATG administration usually triggers a febrile response and is associateds with a characteristic rapid surge of Procalcitonin （PCT） and C-reaction （CRP）.Since the increase of PCT or CRP is not associated with systemic infection,no diagnostic significance for infection is provided by PCT and CRP.PCT and CRP levels are not correlated with liver functions,WBC count or ferroprotein levels.