动态监测PCT、CRP、NE在恶性肿瘤化疗后粒缺期患者中的临床价值

Clinical application value of dynamic monitoring of PCT,CRP and NE in patients with agranulocytosis after malignant tumor chemotherapy

目的分析动态监测降钙素原(PCT)、C反应蛋白(CRP)和中性粒细胞(NE)对恶性肿瘤化疗后粒缺期患者的临床价值。方法选取该院2018年1月至2020年6月收治的恶性肿瘤化疗后粒缺期患者(n=411),根据合并发热的情况,分为发热感染组(n=167)和未发热组(n=244),比较各组PCT、CRP、NE差异,分析发热感染患者的病原菌分布。结果化疗前,各组PCT、CRP、NE差异无统计学意义(P>0.05);化疗后,发热感染组PCT、CRP、NE均高于未发热组,差异有统计学意义(P<0.05)。发热感染组大肠杆菌、真菌、金黄色葡萄球菌/溶血葡萄球菌、肺炎克雷伯杆菌是主要的病原种类,构成比分别为24.55%、20.36%、17.37%、12.57%,其中大肠杆菌、真菌、金黄色葡萄球菌/溶血葡萄球菌的构成比均在15%以上,明显高于其他病原种类构成比(P<0.05)。PCT、CRP、NE预测患者感染时的曲线下面积分别为0.952、0.860、0.897。结论动态监测PCT、CRP、NE可作为预测恶性肿瘤化疗后粒缺期患者病原菌感染种类及预后的重要指标。

Objective To analyze the diagnostic value of dynamic monitoring of procalcitonin(PCT),C-reactive protein(CRP)and neutrophils(NE)in the diagnosis of agranulocytosis after chemotherapy for malignant tumors.Methods Patients with agranulocytosis of malignant tumor after chemotherapy in hospital from January 2018 to June 2020(n=411)were selected and divided into the fever infection group(n=167)and the non-fever group(n=244)according whether there was fever.The differences of PCT,CRP and NE in each group were compared,and the distribution and composition of pathogenic bacteria in the fever infection group were analyzed.Results Before chemotherapy,there was no significant difference in PCT,CRP and NE between the two groups(P>0.05);while after chemotherapy,PCT,CRP and NE in the fever infection group were higher than those in the non-fever group,the difference was statistically significant(P<0.05).In the fever infection group,Escherichia coli,fungi,Staphylococcus aureus/haemolyticus,and Klebsiella pneumoniae were the main pathogens,and the proportions from high to low was 24.55%,20.36%,17.37%and 12.57%,respectively.The constituent ratios of Escherichia coli,fungi and Staphylococcus aureus/haemolyticus were all above 15%,which was significantly higher than that of other pathogens,the difference was statistically significant(P<0.05).The areas under the curve of PCT,CRP and NE in predicting infection was 0.952,0.860 and 0.897,respectively.Conclusion Dynamic monitoring of PCT,CRP and NE can be used as important indicators to predict the types of pathogenic bacteria and prognosis in patients with agranulocytosis after chemotherapy for malignant tumors.