血清降钙素原和C反应蛋白与多发性骨髓瘤患者化疗后粒细胞缺乏伴感染的关联性

Relationship between levels of serum procalcitonin and C-reactive protein and agranulocytosis with infection after chemotherapy in patients with multiple myeloma

目的探讨血清降钙素原(PCT)和C反应蛋白(CRP)水平与多发性骨髓瘤(MM)患者化疗后粒细胞缺乏伴感染的关联性。方法回顾性分析2018年3月~2020年4月间我院收治的120例多发性骨髓瘤患者临床资料,所有患者均处于化疗后粒细胞缺乏期,根据是否合并感染分为感染组(n=64)和未感染组(n=56)。比较两组化疗前、化疗后粒细胞缺乏期实验室指标水平(PCT、CRP),分析各实验室指标单独及联合诊断粒细胞缺乏期感染的效能,分析影响感染发生的因素。结果化疗前,感染组和未感染组PCT、CRP对比差异无统计学意义(P>0.05);化疗后,感染组PCT、CRP水平均高于未感染组(P<0.05);ROC曲线显示:PCT、CRP和联合方案均是诊断粒细胞缺乏期感染的有效指标(P<0.05),联合诊断ROC曲线下面积(AUC)最大;与未感染组比较,感染组住院时间更长(P<0.05),白细胞最低计数<0.8×109者占比更高(P<0.05),中性粒细胞最低值更低和血小板最低值更高(P<0.05)。结论血清降钙素原和C反应蛋白均是诊断多发性骨髓瘤患者化疗后粒细胞缺乏期伴感染的有效指标,且是影响感染发生的独立危险因素,两指标联合检测有利于提高粒细胞缺乏期伴感染的诊断效能。

Objective To investigate the relationship between levels of serum procalcitonin(PCT)and C-reactive protein(CRP)and agranulocytosis with infection after chemotherapy in patients with multiple myeloma(MM).Methods The clinical data of 120 patients with multiple myeloma admitted between March 2018 and April 2020 were retrospectively analyzed.All patients were in the agranulocytosis period after chemotherapy and were divided into infected group(n=64)and uninfected group(n=56)according to whether infection occurred.The levels of laboratory indicators(PCT,CRP)in agranulocytosis period were compared between the two groups before and after chemotherapy,and the efficacy of each laboratory indicator alone and in combination was analyzed in diagnosing infection during agranulocytosis period,and the factors that affected the occurrence of infection were analyzed.Results Before chemotherapy,there were no significant differences in the PCT and CRP between infected group and uninfected group(P>0.05).After chemotherapy,the levels of PCT and CRP during agranulocytosis period in infected group were higher than those in uninfected group(P<0.05).ROC curve showed that PCT,CRP and the combined regimen were all effective indicators for diagnosing infection during agranulocytosis period(P<0.05),and the area under the ROC curve(AUC)of combined diagnosis was the largest.Compared with uninfected patients,the hospital stay of infected patients was longer(P<0.05),and the proportion of the lowest white blood cell count<0.8×109 was higher(P<0.05)while the lowest neutrophil value was lower and the lowest platelet value was higher(P<0.05).Conclusion Serum PCT and CRP are closely related to infection during agranulocytosis period in patients with MM after chemotherapy.Monitoring these two indicators is helpful to provide information for diagnosis and treatment.