HBP、CRP、PCT及IL-6检测在白血病患者合并感染中的诊断价值

Diagnostic value of HBP,CRP,PCT and IL-6 in patients with leukemia complicated with infection

目的探讨肝素结合蛋白(HBP)、C反应蛋白(CRP)、降钙素原(PCT)和白细胞介素-6(IL-6)检测在白血病患者合并感染中的诊断价值。方法对该院150例白血病患者进行回顾性分析,根据患者的感染程度分为无感染组42例、轻度感染组53例和脓毒症组55例,并对脓毒症组根据病原菌类型的不同分为两组,革兰阳性菌感染组29例和革兰阴性菌感染组26例,分别比较HBP、CRP、PCT、IL-6水平在两组患者血液中的表达情况,并采用受试者工作特征曲线(ROC曲线)评价HBP、CRP、PCT、IL-6单独或联合检测在白血病患者合并感染中的诊断价值。结果脓毒症组、轻度感染组与无感染组间HBP、CRP、PCT、IL-6表达水平差异有统计学意义(P<0.05),其中脓毒症组HBP、CRP、PCT、IL-6水平高于轻度感染组和无感染组,差异有统计学意义(P<0.05),轻度感染组中PCT、IL-6水平高于无感染组(P<0.05);HBP、CRP水平与无感染组相比差异无统计学意义(P>0.05);HBP、CRP、PCT、IL-6及4项指标联合检测诊断白血病患者合并感染的曲线下面积分别为0.728、0.691、0.804、0.848和0.934,其中4项指标联合检测的ROC曲线下面积最大,表明其诊断的价值最高。革兰阴性菌感染组HBP、PCT水平高于革兰阳性菌感染组(P<0.05),CRP、IL-6水平两组差异无统计学意义(P>0.05)。结论白血病患者发生感染时HBP、CRP、PCT和IL-6水平将进一步增高,4项指标联合检测可进一步提高诊断价值,并可根据其表达情况判断病原菌感染的类型,为临床合理用药提供依据。

Objective To investigate the diagnostic value of heparin-binding protein(HBP),C-reactive protein(CRP),procalcitonin(PCT)and interleukin-6(IL-6)in patients with leukemia complicated with infection.Methods A retrospective analysis was made on 150 patients with leukemia in this hospital.According to the infection degree of the patients,42 patients were divided into the non-infection group,53 patients in the mild infection group and 55 patients in the sepsis group.And the sepsis group was divided into two groups according to the type of pathogenic bacteria,29 cases were infected by Gram-positive bacteria and 26 cases were infected by Gram-negative bacteria.The levels of HBP,CRP,PCT and IL-6 in blood were compared,the diagnostic value of HBP,CRP,PCT and IL-6 in leukemia patients with infection was evaluated by receiver operating characteristic(ROC)curve.Results The expression levels of HBP,CRP,PCT and IL-6 in sepsis group,mild infection group and non-infection group were significantly different(P<0.05).The levels of HBP,CRP,PCT and IL-6 in sepsis group were significantly higher than those in mild infection group and non-infection group(P<0.05).The levels of PCT and IL-6 in mild infection group were higher than those in non-infection group(P<0.05).The levels of HBP and CRP had no significant difference compared between non-infection group and mild infection group(P>0.05).The area under the curve of single detection and combined detection of HBP,CRP,PCT and IL-6 were 0.728,0.691,0.804,0.848 and 0.934,respectively.The area under the ROC curve of the combined detection of four indicators was the largest,it showed that it was of the highest diagnostic value.The levels of HBP and PCT in Gram-negative bacteria infection group were higher than those in Gram-positive bacteria infection group(P<0.05),but there was no significant difference in CRP and IL-6 between the two groups(P>0.05).Conclusion The levels of HBP,CRP,PCT and IL-6 in leukemia patients would increase when they are infected,and the expression will increase significantly when they has developed sepsis.The combined detection of four indicators can further improve the diagnostic value,according to the level of expression,the type of pathogenic bacteria infection may be interpreted to suggest the clinical use of drugs.