动态监测白血病化疗后粒缺期合并感染患者血清炎性因子水平变化的临床意义

Clinical significance of inflammatory factors serum levels changes in patients after chemotherapy of leukemia with agranulocytosis and bacterial infection

目的探讨血清超敏C-反应蛋白(hs-CRP)、降钙素原(PCT)、白介素-6(IL-6)水平变化在白血病患者化疗后中性粒细胞缺乏期合并感染的诊断价值,为白血病合并感染患者临床治疗提供参考。方法选取2012年1月-2015年12月医院血液科收治的急性白血病患者206例为研究对象,根据患者是否发热分为发热组178例与未发热组28例,对血培养标本进行菌株分离鉴定,观察患者在T0化疗前、T1化疗后3d、T2粒缺期合并发热后第1天、T3抗感染治疗第7天、T4化疗后缓解期血清hs-CRP、PCT、IL-6水平变化。结果两组患者hs-CRP、PCT、IL-6水平比较差异有统计学意义(P<0.05),化疗后粒缺期发热组患者经抗感染治疗后血清hs-CRP、PCT、IL-6均显著降低,治疗前后hs-CRP、PCT、IL-6水平差异有统计学意义(P<0.05);T2粒缺期合并发热患者血清hs-CRP、PCT、IL-6水平均显著高于T1,T3经抗感染治疗后血清hs-CRP、PCT、IL-6水平显著低于T2,差异有统计学意义(P<0.05);发热组患者血培养阳性率为8.99%,血培养阳性与阴性患者hs-CRP和PCT、IL-6水平均差异有统计学意义(P<0.05)。结论动态监测白血病患者化疗后中性粒细胞缺乏期合并感染患者血清hsCRP、PCT、IL-6水平变化,有利于预测细菌感染及细菌感染程度监测、指导抗菌药物使用。

OBJECTIVE To explore the significance of dynamic monitoring of serum high sensitivity C-reactive protein（hs-CRP）,procalcitonin（PCT）,interleukin-6（IL-6）levels in leukemia patients with infections after chemotherapy in period of agranulocytosis,in order to provide reference for clinical treatment for leukemia combined with infection.METHODS A total of 206 patients with acute leukemia from Jan.2012 to Dec.2015 in department of hematology in our hospital were selected.They were divided into fever group（178cases）and non-fever group（28cases）according to whether the patients with or without fever.The blood culture samples were identified with strain isolation.Serum hs-CRP,PCT,IL-6levels were observed in patients before chemotherapy（T0）,3dafter chemotherapy（T1）,1dafter fever in neutropenic（T2）,7dafter anti-infection treatment（T3）,remission after chemotherapy（T4）.RESULTS The hs-CRP,PCT,IL-6levels in two groups had significant difference（P〈0.05）,serum hs-CRP,PCT,IL-6were significantly decreased after anti-infection treatment in fever group after chemotherapy in period of agranulocytosis（P〈0.05）.Serum hs-CRP,PCT,IL-6levels on T2 were significantly higher than T1,T3（P〈0.05）.The blood culture positive rate was 8.99% in patients of fever group.Hs-CRP and PCT,IL-6levels in positive and negative groups were significantly different（P〈0.05）.CONCLUSION The results show that dynamic monitoring of serum hs-CRP,PCT,IL-6levels in neutropenia patients with infection after chemotherapy are conducive to predict the extent of bacterial infection and bacterial infection surveillance,so as to guide the antimicrobial drug use.