BIRCP联合常规检测在白血病患者化疗后骨髓抑制期感染的应用

Application of BIRCP combined with regular detection in infections during bone marrow suppression of hematological malignancies after chemotherapy

目的通过对白血病患者化疗后骨髓抑制期患者感染前后细菌感染相关细胞因子谱(BIRCP)的检测,并结合C-反应蛋白(CRP)等常规检测方法,探讨BIRCP在感染性疾病中的应用价值。方法选取2014年1月-2017年1月于医院住院治疗的急性粒细胞白血病实行化疗后出现骨髓抑制的患者70例,将出现发热、咳嗽等感染症状的患者作为试验组,共60例,以试验组患者化疗前血清中BIRCP细胞因子水平作为基线水平。采用酶联免疫法(ELISA)测定感染发生24h内及感染控制24h后试验组患者的血清肿瘤坏死因子-α(TNF-α)、白细胞介素-2(IL-2)、IL-4、IL-6、IL-10、干扰素-γ(IFN-γ)等细胞因子的水平,并测定CRP和进行血培养,比较BIRCP和CRP的敏感性。并分析血培养阳性患者血清细胞因子的变化规律,进行感染原的判断。结果感染发生24h内6种细胞因子均出现不同程度的升高,其中IL-6、IL-10数值呈现明显的升高,与基线值相比,差异有统计学意义(P<0.05)。感染控制24h后BIRCP中细胞因子水平均出现不同程度下降,其中TNF-α、IL-4、IL-6、IL-10、IFN-γ及CRP的感染前后变化较明显(P<0.05)。在60例有感染症状的患者中,血培养阳性者20例。革兰阳性菌感染患者IL-6升高较明显(P<0.05)。革兰阴性菌感染患者IL-6、IL-10升高较明显(P<0.05)。而真菌感染患者的IFN-γ升高较明显,敏感度和特异性检测中发现IL-10对鉴别革兰阴性菌的敏感度可达80.10%,特异度可达78.20%。结论 BIRCP和CRP均能早期预测白血病患者化疗后骨髓抑制期感染情况,并通过BIRCP的检测可初步判断感染源,指导抗菌药物使用。

OBJECTIVE To explore the rule of bacterial infection related cytokine profile（BIRCP） combined with CRP and its clinical significance in identifying infection risk in the period of bone marrow suppression of hemato- logical malignancies after chemotherapy.METHODS A total of 70 cases of hospitalized patients with acute myelo- cytic leukemia with bone marrow suppression after chemotherapy from Jan. 2014 to Jan. 2017 were enrolled. A- mong them, 60 cases of patients with obvious symptoms such as fever and cough were set as case group. The ser- um BIRCP cytokine levels of case group before chemotherapy were considered as the baseline level. The serum tumor necrosis factor alpha （TNF-alpha）, interleukin 2 （IL-2）, interleukin 4 （IL-4）, interleukin 6 （IL-6）, inter- leukin 10 （IL-10） and gamma interferon （IFN-gamma） of case group were determined within 24 hours of infec- tions and 24 hours after infection control by ELISA method, and the C-reactive protein（CRP） was determined and blood was cultured. The sensitivity of BIRCP and CRP was compared. The change rules of serum levels of cyto- kines in patients with positive blood culture were analyzed, and the infective origin was judged. RESULTS Within the 24 h of infections, 6 kinds of cytokines increased to varying degrees, and there were significant differences in IL-6 and IL-10 values compared with baseline values（P〈0.05）. After 24 hours of infection control, BIRCPcytokine levels decreased in different degrees, the changes of TNF-alpha, IL-4, IL-6, IL-10, IFN- gamma and CRP were the most significant （P〈0.05）. Among 60 cases of patients with symptoms of infections, there were 20 cases of patients with positive blood culture . IL-6 increased more significantly in patients with gram-positive bac- teria infection（P〈0.05）. Both IL-6 and IL-10 increased more significantly in patients with gram-negative bacteria infection （P〈0.05）. IFN-7 increased significantly in the fungal infection group. The sensitivity and specificity tests found that IL-10 was superior to other cytokines in the identification of gram-negative bacteria, with a sensi- tivity of 80.10% and a specificity of 78.20%. CONCLUSION BIRCP and CRP can predict early infection status of adult leukemia bone marrow suppression after chemotherapy, and can preliminary judge original infections through BIRCP detection and guide the antibiotic use.