移植预处理中使用抗人胸腺细胞免疫球蛋白后降钙素原检测对细菌感染的诊断价值探讨

The role of procalcitonin in the diagnosis of bacterial infection after anti-thymocyte globulin(ATG)in conditioning of hematopoietic stem cell transplantation(HSCT)

目的 探讨造血干细胞移植（HSCT）预处理治疗中应用抗人胸腺细胞免疫球蛋白（ATG）后监测血浆降钙素原（PCT）对区分细菌感染和非感染性炎症是否有帮助。方法 本研究纳入了60例重型地中海贫血患儿,这些患儿均接受了HSCT,预处理方案包括环磷酰胺、氟达拉滨、白舒非、噻替哌以及ATG（总剂量：即复宁ATG 5 mg/kg,费森尤斯ATG;-F 15~30 mg/kg,从移植前的-3 d至-1 d分3次应用）。移植前的-3d至0d每天早晨抽取血液标本检测PCT和C反应蛋白（CRP）,同时记录每日体温变化。根据是否应用抗生素,患者被分为使用抗生素组（30例）,未使用抗生素组（30例）,其中又根据血培养结果分为血培养阳性组（7例）,血培养阴性组（47例）,另有6例未在1周内行血培养。结果使用抗生素组与未使用抗生素组之间4 d PCT值变化趋势相同,治疗方法与时间之间无交互作用（F=1.570,P=0.208）,两组间差别无显著性（P=0.061）。血培养阳性组与血培养阴性组之间PCT值变化趋势不同,血培养结果与时间之间有交互作用（F=3.747,P=0.021）,各时点内两组间比较差异均无显著性（P值均≥0.058）。以4 d PCT值作为诊断感染的ROC：曲线的曲线下面积（AUC）均小（≤0.567）,诊断价值低。结论 本研究表明,HSCT预处理治疗中应用ATG的患儿PCT值增高对于区分细菌感染和非感染性炎症反应没有意义。

Objective To find out whether infection and non-bacterial inflammation after hematopoietic stem cell transplantation （HSCT） Procalcitonin （PCT） is helpful to differentiate bacterial anti-thymocyte globulin （ATG） in conditioning of Methods 60 patients were enrolled in current study, who underwent HSCT and received conditioning included Cyclophosphamide, Fludarabine, Busufan, Thiotepa and ATG （ at total dose of 5mg/kg for thymoglobulin, and 15-30mg/kg for ATG-Fresenius, respectively, on day-3 to -1 ）. Blood samples were obtained in the morning from day-3 to ＋ 2 for testing PCT and CRP associated by daily recording temperature. Patients were divided into Group 1 （ G1, with antibiotics, n = 30）, Group 2 （G2, without antibiotics, n = 30）, Group 3 （G3, bacteria culture positive, n = 7 ） and Group 4 （ G4, bacteria culture negative, n = 47 ）. Results PCT value of Group G1 and Group G2 has the same change trend during the 4 days, No interaction between treatment and time （F = 1. 570, P = 0. 208）, the difference between the two groups has no statistical significance （P = 0. 061 ）, Group G3 and G4 has different changing trends. There is interaction between blood culture result and time（F = 3. 747, P = 0. 021 ）, but differences between the two groups at each time point have no significance （P ≥0. 058 ）. We put PCT as criteria for the diagnosis of infection. The areas under the ROC curve （AUC） are all small （ ≤0. 567）, which indicate low diagnostic value. Conclusions The current study shows the value of PCT is no point to differentiate bacterial infection and non-bacterial inflammation after use of ATG in conditioning of HSCT.