降钙素原和免疫炎性因子在粒细胞减少的恶性血液病菌血症患者中的临床应用价值

Application Value of Procalcitonin and Immune Inflammatory Factors for Prediction of Bacteriemia in Patients with Hematologic Malignancy Combined with Febrile Neutropenia

本研究探讨降钙素原(procalcitonin,PCT)、免疫炎性因子C-反应蛋白(C-reactive protein,CRP)、血清淀粉样蛋白A(serum amyloid A,SAA),白介素-6(interleukin-6,IL-6)对中性粒细胞减少的恶性血液病菌血症患者的诊断价值。对四川大学华西医院2011年3月-2012年10月确诊为恶性血液病伴发热的1253例住院患者进行了回顾性分析,按照严格的纳入排除标准选取297例,以血培养作为金标准分为菌血症组和非菌血症组,分析数据,评价诊断效能。结果表明:在恶性血液病粒细胞减少的患者中,菌血症组患者血清PCT、CRP、IL-6以及SAA水平较非菌血症组增高,差异具有统计学意义(P<0.05)。PCT的曲线下面积(AUC)为0.974(P<0.05),明显优于CRP(AUC=0.681,P<0.05)、IL-6(AUC=0.661,P<0.05)和SAA(AUC=0.605,P<0.05),差异具有统计学意义。当PCT的cut-off值为1.06 ng/ml时,灵敏度达95.8%,特异度达92.1%,Youden指数为0.879,阴、阳性预测值分别为97.8%和85.0%,阴、阳性似然比分别为0.05和12.2,均明显优于CRP、IL-6和SAA。结论:在恶性血液病中性粒细胞减少合并细菌感染的患者中,血清PCT的诊断效能优于传统免疫炎性因子CRP、IL-6、SAA。PCT可作为预测细菌感染的一个快速可靠的指标,为临床合理使用抗生素、降低死亡风险提供实验室依据。

This study was purposed to evaluate the diagnositic value of procalcitonin （ PCT）, C-reactive protein, interleukin-6 （IL-6）, serum amyloid A （SAA） for bacteremia in patients with hematologic malignancy combined with febrile neutropania. The total of 297 patients with hematologic malignancy combined with febrile neutropania were analyzed retrospectively from 1253 patients admitted to West China hospital of Sichuan University from March 2011 to Octerber 2012. They were divided into sepsis group （n = 95 ） and non-sepsis group （n = 202 ） according to blood culture. The results showed that the levels of PCT, CRP, IL-6 and SAA in sepsis group were higher than those in non-sepsis group, and there was statistically significant difference between these two groups （ P 〈 0.05 ）. The PCT had an AUC value of 0. 974 （ P 〈 0.05）, and obviously higher than that of CRP （ AUC = 0. 681, P 〈 0.05 ）, IL-6 （ AUC = 0. 661, P 〈0.05） and SAA （AUC =0. 605, P 〈0.05）. When PCT had cut-off value of 1.06 ng/ml, sensitivity of 95.8%, specificity of 92.1%, and the Youden indicator of 0. 879, the negative and positive predictive values were 97.8% and 85.0% respectively, the negative and positive likelihood ratios were 0.05 and 12.5 respectively, and all significanlly higher than that of CRP, IL-6 and SAA. It is concluded that for patients with hematologic malignancy combined with febrile neutropenia and bacterial infection, the diagnostic value of serum PCT is superior to that of immune inflammatory factors（CRP, 1L-6 and SAA）, the PCT can predict the bacterium infection, provide laboratory evidence for rational antimicrobial drug usage and mortality reduction.