外周血CD64及血清PCT、hs- CRP水平在急性白血病化疗后合并细菌感染中的应用

The Diagnostic Application of Peripheral Blood CD64, Serum PCT and hs-CRP Levels in Acute Leukemia Combined with Bacterial Infection After Chemotherapy

目的分析外周血中性粒细胞CD64及血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)水平在急性白血病(AL)化疗后合并细菌感染中的评估价值。方法选取2016年10月至2019年9月我院收治的AL患者95例为研究对象,均接受单次或多次化疗,依据化疗后是否出现细菌感染将其分为感染组、未感染组,另选择同期于我院体检的健康志愿者30例作为对照组,比较三组入院时外周血CD64及血清PCT、hs-CRP水平,分析感染组中不同感染程度、不同类型细菌感染、脓毒症患者治疗前后外周血CD64及血清PCT、hs-CRP水平,分析感染者中外周血CD64及血清PCT、hs-CRP水平相关性,绘制受试者工作特征曲线(ROC)分析外周血CD64、PCT及hs-CRP水平对AL化疗后合并细菌感染的预测价值。结果感染组外周血CD64及血清PCT、hs-CRP水平高于未感染组、对照组,未感染组、对照组各指标比较差异也有统计学意义(P<0.05);合并细菌感染者中,普通感染者外周血CD64及血清PCT、hs-CRP水平低于脓毒症患者(P<0.05);合并细菌感染者中,感染革兰阴性菌患者外周血CD64及血清PCT水平高于感染革兰阳性菌患者(P<0.05),而hs-CRP水平比较差异无统计学意义(P>0.05);脓毒症患者治疗后外周血CD64及血清PCT、hs-CRP水平低于治疗前(P<0.05);Pearson相关分析显示,合并细菌感染者外周血CD64、PCT及hs-CRP两两存在正相关性(P<0.05);ROC曲线分析发现,外周血CD64及血清PCT、hs-CRP联合预测AL化疗后合并细菌感染的曲线下面积为0.895,均高于各指标单独预测。结论外周血CD64及血清PCT、hs-CRP与AL患者化疗后合并细菌感染患者感染程度、感染的细菌类型有密切关系,三者联合检测对AL化疗后细菌感染有较高诊断价值,值得在临床推广实践。

Objective To analyze the evaluation diagnostic values of peripheral blood neutrophil CD64, serum procalcitonin(PCT) and high-sensitivity C-reactive protein(hs-CRP) levels in acute leukemia(AL) combined with bacterial infection after chemotherapy.Methods A total of 95 AL patients who were admitted to the hospital from October, 2016 to September, 2019 were enrolled as study subjects. All patients underwent one-time or multiple times of chemotherapy. According to presence or absence of bacterial infection after chemotherapy, these patients were divided into the infection group and non-infection group. Another 30 healthy volunteers who underwent physical examination in the hospital during the same period were enrolled as the control group. The levels of peripheral blood CD64, serum PCT and hs-CRP in peripheral blood at admission were compared among the three groups. The levels of peripheral blood CD64, serum PCT and hs-CRP before and after treatment among patients with different infection degree, different types of bacterial infection, and sepsis in the infection group were also analyzed.Correlation among levels of peripheral blood CD64, serum PCT and hs-CRP in infection patients was analyzed. The receiver operating characteristic(ROC) curves were drawn to evaluate predictive value of peripheral blood CD64, PCT and hs-CRP levels on AL combined with bacterial infection after chemotherapy.Results The levels of peripheral blood CD64, serum PCT and hs-CRP in the infection group were higher than those in the non-infection group and control group(P<0.05). There were also significant differences in all indexes between the non-infection group and control group(P<0.05). Among patients with bacterial infection, levels of peripheral blood CD64, serum PCT and hs-CRP in patients with common infection were lower than those in sepsis patients(P<0.05). Levels of peripheral blood CD64 and serum PCT in patients infected by Gram-negative bacteria were higher than those in those infected by Gram-positive bacteria(P<0.05), but there was no significant difference in hs-CRP level(P>0.05). After treatment, levels of peripheral blood CD64, serum PCT and hs-CRP in sepsis patients were lower than those before treatment(P<0.05). Pearson correlation analysis showed that there was a positive correlation between any two of peripheral blood CD64, PCT and hs-CRP in bacterial infection patients(P<0.05). ROC curve analysis showed that the area under the curve of peripheral blood CD64 combined with PCT and hs-CRP for predicting AL combined with bacterial infection after chemotherapy was 0.895, which was higher than that of single index(P<0.05).Conclusion Peripheral blood CD64, PCT and hs-CRP are closely related to infection degrees and infected bacteria types in patients with bacterial infection and AL after chemotherapy. The combined detection of the three markers has a high diagnostic value on bacterial infection after AL chemotherapy. It is worth popularizing in clinical practice.