血清PCT及CRP的联合检测在血液病粒细胞缺乏伴发热血流感染的诊断价值

Diagnostic value of combined detection of serum PCT and CRP in hematologic agranulocytosis with febrile bloodstream infection

目的探讨血清降钙素原(PCT)及C反应蛋白(CRP)的联合检测对血液病粒细胞缺乏伴发热血流感染的诊断价值。方法回顾性分析,收集2016年1月~2019年5月于我院血液科就诊的血液病粒细胞缺乏伴发热患者401例,其中血流感染阳性组106例,非血流感染阴性组295例,血流感染组均已接受血培养并鉴定菌属。分析病原菌分布情况;血流感染阳性组患者与非血流感染阴性组患者PCT、CRP水平比较;绘制ROC曲线,分析PCT与CRP对血液科血流感染的敏感度与特异度。结果血流感染阳性组患者106例,其中革兰阴性菌88株,占比83.02%(88/106),革兰阳性菌18株,占比16.98%(18/106),差异有统计学意义(χ^2=92.453,P=0.000);血流感染阳性组PCT、CRP水平均比非血流感染阴性组高,差异有统计学意义(P<0.05);经ROC曲线证实,PCT、CRP单一检测与联合检测用于血流感染评估的ROC曲线面积分别为:AUC=0.800、0.864、0.868,当PCT、CRP临界值为0.11 ng/mL、6.30 mg/L,联合检测为1.95时,可得到最理想的灵敏度和特异度,分别为0.953、0.634;0.972、0.780;0.991、0.936。结论PCT及CRP联合检测血液病粒细胞缺乏伴发热血流感染疾病诊断价值较高,可帮助临床了解患者血流感染情况,对疾病的治疗及预后改善均有一定价值。

Objective To explore the diagnostic value of the combined detection of procalcitonin(PCT)and C-reactive protein(CRP)in hematologic agranulocytosis with febrile bloodstream infection.Methods A retrospective analysis was conducted,and 401 patients with hematologic agranulocytosis with fever who were admitted to the hematology department of our hospital from January 2016 to May 2019 were collected.There were 106 patients in the bloodstream infection positive group and 295 patients in the no bloodstream infection negative group.All the patients in the bloodstream infection group were treated with blood culture and the bacterial genera were identified.The distributions of pathogenic bacteria were analyzed.The levels of PCT and CRP in agranulocytosis patients with and without bloodstream infection were compared.ROC curves were drawn to analyze the sensitivity and specificity of PCT and CRP to bloodstream infection in the hematology department.Results In the bloodstream infection positive group including 106 patients,88 strains of gram-negative bacteria were detected,accounting for 83.02%(88/106)and 18 strains of gram-positive bacteria were detected,accounting for 16.98%(18/106),and the difference was statistically significant(χ2=92.453,P=0.000).The levels of PCT and CRP in the bloodstream infection positive group were higher than those in the no bloodstream infection negative group,and the differences were statistically significant(P<0.05).As confirmed by the ROC curves,the ROC curve areas of only PCT,only CRP and the combined detection for the bloodstream infection assessment were:AUC=0.800,0.864 and 0.868,respectively.When the critical values of PCT and CRP were 0.11 ng/mL and 6.30 mg/L,and the combined detection was 1.95,the optimal sensitivity and specificity could be obtained,which were 0.953,0.634;0.972,0.780;0.991,0.936,respectively.Conclusion The combined detection of PCT and CRP is of high diagnostic value in the diagnosis of hematologic agranulocytosis with febrile bloodstream infection,which can help the clinical understanding of patients'bloodstream infection condition,and has certain value in the treatment and prognosis improvement of the disease.