摘要
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.
出处
《中国小儿血液与肿瘤杂志》
CAS
2016年第6期300-304,共5页
Journal of China Pediatric Blood and Cancer
关键词
造血干细胞移植
抗人胸腺细胞免疫球蛋白
降钙素原
细菌感染
非感染性炎症
Hematopoietic stem cell transplantation
Anti-thymocyte globulin (ATG)
Procalcitonin
Bacterial infection
Non-infective systemic inflammation