肿瘤晚期患者感染与肿瘤热早期诊断的临床研究

Clinical study on early diagnosis of infections and tumor-related fever in advanced cancer patients

目的探讨血清降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)等鉴别肿瘤晚期患者感染与肿瘤热的临床意义,快速鉴别感染与肿瘤热,指导临床医疗。方法回顾性分析2012年1月-2014年6月医院110例肿瘤晚期患者临床资料,按发热类型分为3组,其中无发热患者为对照组24例、肿瘤性发热为肿瘤热组32例、细菌感染性发热为感染组54例,比较3组患者血清PCT、白细胞计数(WBC)、hs-CRP、中性粒细胞计数(NEUT)及中性粒细胞比率(NEUT%)。结果感染组患者PCT为(1.63±1.91)ng/ml,显著高于肿瘤热组的(0.16±0.10)ng/ml及对照组的(0.11±0.13)ng/ml(P<0.001),3组患者的hs-CRP、WBC、NEUT、NEUT%比较,差异均无统计学意义;感染组患者经抗感染治疗2周后复查,40例治愈者PCT均值为(0.27±0.23)ng/ml,14例死亡者PCT均值为(16.8±13.6)ng/ml,差异有统计学意义(P<0.001);败血症患者PCT水平(3.71±2.80)ng/ml,显著高于肺部感染患者(1.24±1.16)ng/ml、泌尿系感染患者(0.61±0.22)ng/ml及腹腔感染患者(0.54±0.19)ng/ml(P=0.015)。结论 PCT在鉴别肿瘤热与感染性发热中有重要意义,且在败血症患者中表达明显增高,hs-CRP、WBC、NEUT、NEUT%在鉴别肿瘤晚期患者肿瘤热与感染性发热中无显著意义。

OBJECTIVE To explore the clinical significance of serum procalcitonin（PCT）,high-sensitivity C-reactive protein（hs-CRP）in distinguishing between infections and tumor-related fever in advanced cancer patients so as to provide guidance for rapid identification of infections and tumor-related fever.METHODS The clinical data of110 advanced cancer patients who were treated in the hospital from Jan 2012 to Jun 2014 were retrospectively analyzed.The enrolled patients were divided into three groups according to the type of fever,the patients without fever were assigned as the control group,32 patients with tumor-induced fever were assigned as the tumor fever group,and 54 patients with bacterial infection-induced fever were set as the bacterial infection group.The levels of serum PCT,white blood cell（WBC）counts,hs-CRP,Neutrophil（NEUT）counts,and percentage of NEUT（NEUT%）were observed and compared among the three groups of patients.RESULTS The PCT level of the infection group was（1.63±1.91）ng/ml,significantly higher than（0.16±0.10）ng/ml of the tumor fever group and（0.11±0.13）ng/ml of the control group（P〈0.001）.There was no significant difference in the hs-CRP,WBC,NEUT,or NEUT% among the three groups of patients.The re-examination that was conducted for the patients in the infection group after the anti-infection treatment for 2weeks showed that 40 cases were cured with the average PCT value of（0.27±0.23）ng/ml,14 cases died with the average PCT value of（16.8±13.6）ng/ml,and there was significant difference（P〈0.001）.The PCT level of the patients with sepsis was（3.71±2.80）ng/ml,significantly higher than（1.24±1.16）ng/ml of the patients with pulmonary infections,（0.61±0.22）ng/ml of the patients with urinary system infections,and（0.54±0.19）ng/ml of the patients with abdominal infections（P=0.015）.CONCLUSIONThe PCT has great significance in distinguishing between the tumor fever and the infection-induced fever and is significantly high in the patients with sepsis.There is no significant difference in distinguishing between the tumor fever and the infection-induced fever among the hs-CRP,WBC,NEUT,and NEUT%.