血清PCT联合细胞因子对白血病儿童感染的诊断效果

Diagnostic effect of serum PCT combined with cytokines on secondary infection of children with leukemia

目的 分析血清降钙素原(PC T)联合细胞因子对白血病儿童感染的诊断效果.方法 选取2018年1月至2019年12月期间丽水市人民医院收治的102例白血病同时有感染的患儿为观察组,并选取同期我院收治的102例白血病无感染患儿为对照组.检测观察组发热前(T0)、发热后第1d(T1)、第3d(T2)、第7d(T3)时的血清白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、干扰素γ(IFN-γ)、C反应蛋白(CRP)、PCT水平;检测无感染白血病患儿(对照组)入院后第1d(T0)、第2d(T1)、第4d(T2)、第8d(T3)时的上述指标.将两组数据进行比较,并对各指标的ROC曲线进行分析.结果 T0时刻两组的血清IL-6、IL-8、IFN-γ、CRP、PCT水平比较无差异(均P>0.05);T1~T3时刻观察组的血清IL-6、CRP、PCT水平均高于对照组,且观察组的血清IL-6、CRP、PCT水平呈现先升高后降低的趋势,在T1时刻达到高峰,有统计学意义(t值分别为2.292、3.098、2.279,均P<0.05).T1~T3时刻观察组的血清IL-8、IFN-γ水平均低于对照组,且观察组的血清IL-8、IFN-γ水平呈现先降低后升高的趋势,在T1时刻达到最低值,有统计学意义(t值分别为2.389、2.479,均P<0.05).对各指标的受试者工作特征曲线(ROC曲线)进行分析,将不小于最佳截取点的值赋值为1,小于该值赋值为0,结果显示将IL-6、IL-8、PC T联合诊断的曲线下面积(A U C)为0.987(95%C I为0.981~0.997),预测的敏感性为89.43%,特异度为100%,优于其他各指标单独使用的效果.结论 较其他常规血清指标,PC T对白血病儿童感染的诊断有较高的特异度,但PC T与IL-6、IL-8等指标联合诊断的效果更佳.

Objective To analyze diagnostic effect of serum procalcitonin(PCT)combined with cytokines on secondary infection of the children with leukemia.Methods 102 children with leukemia and secondary infection who admitted to our hospital from January 2018 to December 2019 were selected as observation group,and 102 uninfected children with leukemia during the same period were selected as the control group.Serum levels of interleukin-6(IL-6),interleukin-8(IL-8),interferon-γ(IFN-γ),C-reactive protein(CRP)and PCT of the children in the observation group were detected before fever(T0),at 1 d after fever(T1),at 3 d after fever(T2)and at 7 d after fever(T3).While the serum levels of all indexes as mentioned above of the uninfected children with leukemia in the control group were detected at respective the first day(T0),2 d(T1),4 d(T2)and 8 d(T3)after hospitalization.The data of the children were compared between the two groups,and the ROC curve of the indexes were analyzed.Results There were no significant differences in serum levels of IL-6,IL-8,IFN-γ,CRP and PCT levels between the two groups at T0(all P>0.05).The serum levels of IL-6,CRP and PCT of the children in the observation group at T1~T3 were higher than those of the children in the control group,and showed a trend of increase first and decrease then,reaching a peak at T1,there were significant differences between the two groups(t=2.292,3.098 and 2.279 respectively,all P<0.05).While the serum levels of IL-8 and IFN-γof the children in the observation group at T1~T3 were lower than those of the children in the control group,and showed a trend of decrease first and increase then,reaching the lowest values at T1,there were significant differences between the two groups(t=2.389 and 2.479,respectively,both P<0.05).In analysis of the ROC curve of all indexes,the value not less than the optimal cut-off point was assigned as 1,and the value less than this value was assigned as 0.The results showed that the AUC of combined diagnosis of IL-6,IL-8 and PCT was 0.987(95%CI:0.981~0.997),when the sensitivity for prediction was 89.43%and the specificity was 100%,which were better than other single indexes alone.Conclusion Compared with other conventional serum indexes,PCT has a higher specificity for the diagnosis of secondary infection of the children with leukemia,while the diagnostic effect of PCT combined with IL-6,IL-8 and other indexes is better.