降钙素原联合超敏C反应蛋白诊断血液病伴粒细胞缺乏合并血流感染的临床研究

Clinical value of procalcitonin combined with high-sensitivity C-reactive protein in diagnosis of neutropenia hematologic malignancies patients with bloodstream infection

目的探讨降钙素原(PCT)联合超敏C反应蛋白(hs-CRP)诊断血液病伴粒细胞缺乏合并血流感染的临床价值。方法选取2016年2月至2018年7月经本院诊治的血液病伴粒细胞缺乏患者129例,根据是否合并血流感染分为感染组(n=56)和对照组(n=73),根据感染组患者致病菌种类的不同分为革兰阳性菌组(n=21)及革兰阴性菌组(n=35)。采用免疫定量分析仪HR201检测血清PCT水平;采用日立全自动生化分析仪7600-020检测血清hs-CRP水平,比较各组患者PCT、hs-CRP及WBC的水平。采用受试者工作特征曲线(ROC)下面积(AUC)评价各指标诊断血液病伴粒细胞缺乏合并血流感染的价值。结果感染组患者PCT、WBC、hs-CRP水平均明显高于对照组(P<0.05);革兰阳性菌组患者血清PCT水平明显低于革兰阴性菌组(P<0.05),但两组患者WBC计数、hs-CRP水平的比较无统计学差异(P>0.05);WBC诊断血液病伴粒细胞缺乏合并血流感染的AUC、敏感度及特异度分别为0.664(95%CI:0.643-0.682)、3.57%和95.89%,hs-CRP诊断血液病伴粒细胞缺乏合并血流感染的AUC、敏感度及特异度分别为0.883(95%CI:0.864-0.903)、89.28%和82.14%,PCT诊断血液病伴粒细胞缺乏合并血流感染的AUC、敏感度及特异度分别为0.976(95%CI:0.962-0.989)、87.50%和91.07%,PCT联合hs-CRP诊断血液病伴粒细胞缺乏合并血流感染的AUC、敏感度及特异度分别为0.992(95%CI:0.982-0.998)、92.86%和96.43%。结论WBC诊断血液病伴粒细胞缺乏合并血流感染的价值不佳,PCT联合hs-CRP检测有利于提高诊断血液病伴粒细胞缺乏合并血流感染的价值。

Objective To investigate the clinical value of procalcitonin(PCT)combined with high-sensitivity C-reactive protein(hs-CRP)in the diagnosis of neutropenia hematologic malignancies patients with bloodstream infection.Methods A total of 129 patients with neutropenia hematologic malignancies who were diagnosed and treated in our hospital from February 2016 to July 2018 were enrolled.According to whether they were infected with bloodstream infection,they were divided into infection group(n=56)and control group(n=73).According to the different types of pathogenic bacteria in the infected group,Gram-positive bacteria group(n=21)and Gram-negative bacteria group(n=35)were divided.Serum PCT level was detected by immunoassay analyzer HR201;serum hs-CRP level was detected by Hitachi automatic biochemical analyzer 7600-020;the levels of PCT,hs-CRP,and WBC counts in each group were compared.The area(AUC)under the receiver operating characteristic curve(ROC)was used to evaluate the value of each index in diagnosing neutropenia hematologic malignancies patients with bloodstream infection.Results The PCT,WBC count and hs-CRP levels in the infected group were significantly higher than those in the control group(P<0.05);the serum PCT level of Gram-positive bacteria group was significantly lower than that of Gram-negative bacteria group(P<0.05),but there was no significant difference in WBC count and hs-CRP level between the two groups(P>0.05).The AUC,sensitivity and specificity of WBC count for diagnosis of neutropenia hematologic malignancies patients with bloodstream infection were 0.664(95%CI:0.643-0.682),3.57% and 95.89%,respectively;the AUC,sensitivity and specificity of hs-CRP were 0.883(95%CI:0.864-0.903),89.28% and 82.14%,respectively;the AUC,sensitivity and specificity of PCTwere 0.976(95%CI:0.962-0.989),87.50% and 91.07%,respectively;the AUC,sensitivity and specificity of PCT combined with hs-CRP were 0.992(95%CI:0.982-0.998),92.86% and 96.43%,respectively.Conclusion PCT combined with hs-CRP detection,which is superior toWBC count alone,is helpful to improve the diagnostic value of neutropenia hematologic malignancies patients with bloodstream infection.