白细胞介素-6、C-反应蛋白和降钙素原对儿童血液肿瘤感染的预测价值

Interleukin-6,C-reactive protein and procalcitonin in prediction of pediatric hematological tumor infection

目的探讨白细胞介素-6(IL-6)、血清C-反应蛋白(CRP)、降钙素原(PCT)对血液肿瘤患儿感染的预测价值。方法回顾性分析120例血液肿瘤患儿的临床资料,依据感染情况及感染程度进行分组,比较其血清IL-6、CRP及PCT水平。采用受试者工作特征(ROC)曲线及曲线下面积(AUC)分析血清IL-6、CRP及PCT预测血液肿瘤患儿感染的价值,确定临界值;血液肿瘤患儿感染的影响因素采用多因素Logistic回归分析。结果本研究共纳入120例血液肿瘤患儿,未发生感染87例,发生感染33例,感染率为27.50%(33/120),分别作为感染组(n=33)和非感染组(n=87),并依据感染程度分为临床感染组(n=18)及感染性休克组(n=15)。感染性休克组患儿血清IL-6、CRP及PCT水平均高于临床感染组和未感染组患儿,临床感染组患儿血清IL-6、CRP及PCT水平均高于未感染组患儿,差异均有统计意义(P<0.05)。ROC曲线结果显示,IL-6、CRP及PCT诊断儿童血液肿瘤感染的AUC分别为0.800、0.958、0.742,诊断灵敏度分别为0.552、0.954、0.805,临界值分别为63.86 ng/L、9.93 mg/L、0.17 ng/L。Logistic回归分析结果显示,感染可能性评分(IPS)≥12分、IL-6≥63.86 ng/L、CRP≥9.93 mg/L及PCT≥0.17 ng/L均是血液肿瘤患儿感染的独立危险因素(P<0.05)。结论IL-6、CRP与PCT对血液肿瘤患儿感染有一定预测价值,其水平越高,表明感染程度越严重。

Objective To explore the predictive value of interleukin-6(IL-6),serum C-reactive protein(CRP)and procalcitonin(PCT)in predicting infection of children with hematological tumors.Method The clinical data of 120 children with hematological tumors were analyzed retrospectively.The patients were divided into two groups according to the infection and degree,and the levels of serum IL-6,CRP and PCT were compared.The predicative value of serum IL-6,CRP and PCT was analyzed by receiver operating characteristic curve(ROC)and area under curve(AUC),and the critical values determined.Multivariate Logistic regression analysis was used to analyze the influencing factors of infection.Result A total of 120 children with hematological tumors were included and divided into infection group(n=33)and non-infection group(n=87),with infection rate of 27.50%(33/120).According to the degree of infection,the infection group were divided into clinical infection group(n=18)and infectious shock group(n=15).The serum levels of IL-6,CRP and PCT in infectious shock group were higher than those in clinical infection group and non-infection group,and the clinical infection group significantly higher than those in non-infection group(P<0.05).The results of ROC curve showed that the AUC of IL-6,CRP and PCT in the diagnosis of blood tumor infection in children were 0.800,0.958 and 0.742,the diagnostic sensitivity 0.552,0.954 and 0.805,and the critical values 63.86 ng/L,9.93 mg/L and 0.17 ng/L,respectively.Logistic regression analysis showed that infection probability score(IPS)≥12 score,IL-6≥63.86 ng/L,CRP≥9.93 mg/L and PCT≥0.17 ng/L were independent risk factors for infection in children with hematological tumors.Conclusion IL-6,CRP and PCT are of value in predicting infection in children with hematological tumors,higher levels indicating higer severity.