白血病化疗相关感染的CRP及PCT动态监测

Dynamic monitoring of CRP and PCT of leukemia children with chemotherapy-related infection

目的探究小儿白血病化疗后早期细菌感染血清C-反应蛋白(C reactive protein,CRP)、降钙素原(Procalcitonin,PCT)的动态变化及其临床价值。方法收集南昌大学第一附属医院儿科2017年7月-2019年7月收治的小儿急性淋巴细胞白血病(Acute lymphoblastic leukemia,ALL)的患儿90例作为研究对象,根据其化疗期间是否发生感染分为感染组(n=42)和非感染组(n=48)。检测分析患儿入院当天化疗前,化疗后1、3、7 d的血清CRP、PCT水平。结果 42例感染组患儿在化疗后30 d内共发生感染67例次,其中呼吸道感染发生频率最高为41.79%;42例感染患儿共检出病原菌49株,以革兰阴性菌为主,占61.22%,其中铜绿假单胞菌占22.45%;化疗后1、3、7 d感染组CRP、PCT水平高于非感染组(P<0.05);ROC分析结果显示,血清CRP、PCT水平对ALL患儿发生细菌感染具有良好的诊断价值,截断值分别为12.53 mg/L、0.23 ng/ml,差异具有统计学意义(P<0.001)。结论小儿白血病化疗后CRP、PCT的动态变化对于发生细菌感染具有较好的预测价值,值得进行临床推广。

OBJECTIVE To investigate the dynamic changes of serum C-reactive protein(CRP) and procalcitonin(PCT) in early bacterial infection after chemotherapy in children with leukemia and its clinical value. METHODS Total of 90 children with acute lymphoblastic leukemia(ALL) admitted to the Department of Pediatrics, the First Affiliated Hospital of Nanchang University from Jul. 2017 to Jul. 2019 were enrolled as the research objects, and divided into the infection group(n=42) and non-infected group(n=48), according to whether infection occurred during chemotherapy. Serum CRP and PCT levels were measured before chemotherapy, 1 day, 3 days and 7 days after chemotherapy. RESULTS A total of 67 cases of infection occurred in the 42 infected children within 30 days after chemotherapy, and the incidence of respiratory infection was the highest(41.79%);a total of 49 strains of pathogens were isolated in 42 infected children with Gram-negative bacteria accounting for 61.22 %, of which P. aeruginosa accounted for 22.45%;CRP and PCT levels in the infected group were significantly higher than that in the non-infected group 1, 3, and 7 days after chemotherapy(P<0.05);ROC analysis showed that serum CRP and PCT level had a good diagnostic value for the bacterial infection in children with ALL, and the cutoff values were 12.53 mg/L and 0.23 ng/ml, respectively;the difference between groups was significant(P<0.001). CONCLUSION The dynamic changes of CRP and PCT after pediatric leukemia chemotherapy had a good predictive value for the bacterial infection, and it was worthy of clinical promotion.