mIPS评分联合T淋巴细胞亚群对恶性血液病化疗粒细胞缺乏期并发血流感染的预测价值

Prediction value of mIPS score combined with T lymphocyte subsets for bloodstream infection during chemotherapy granulocyte-deficient stage in hematologic malignancies

目的 研究恶性血液病化疗粒细胞缺乏期并发血流感染诊断中改良后的感染可能性评分(mIPS评分)联合T淋巴细胞亚群的价值。方法 以回顾性分析为法,观察对象为2020年1月至2022年1月入海南医学院第二附属医院的60例恶性血液病且接受化疗患者,参考血流感染发生情况分为研究组(感染,n=20)与对照组(未感染,n=40)。比较两组患者粒细胞化疗前与缺乏期mIPS评分、T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)),选取受试者工作特征(ROC)曲线对血流感染诊断效能予以评估,并对恶性血液病化疗粒细胞缺乏期并发血流感染的影响因素予以Logistic多因素回归分析。结果 粒细胞缺乏期,两组患者mIPS评分较化疗前显著升高,且研究组粒细胞缺乏期mIPS评分为(15.28±1.97)分,较对照组[(8.01±1.84)分]更高,差异均有统计学意义(P<0.05)。粒细胞缺乏期,两组患者CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)较化疗前显著下降,且研究组粒细胞缺乏期CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)分别为(25.31±3.38)%、(13.63±4.32)%、0.55±0.19,较对照组[(33.36±4.62)%、(16.47±4.08)%、0.73±0.22]更低,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,mIPS评分预测恶性血液病化疗粒细胞缺乏期并发血流感染的曲线下面积(AUC)为0.819,CD3^(+)预测的AUC为0.696,CD4^(+)的AUC为0.693,CD4^(+)/CD8^(+)的AUC为0.747,mIPS评分联合T淋巴细胞亚群的AUC为0.897。Logistic多因素回归分析结果显示,mIPS评分为血流感染的危险因素(P<0.05),T淋巴细胞亚群为血流感染的保护因素(P<0.05)。结论 恶性血液病化疗粒细胞缺乏期并发血流感染诊断中mIPS评分联合T淋巴细胞亚群的预测价值显著,可为防治血流感染提供十分有利的参考依据。

Objective To investigate the value of the modified infection likelihood score(mIPS)combined with T lymphocyte subsets in the diagnosis of bloodstream infection during the chemotherapy phase of granulocytosis in malignant hematologic diseases.Methods By retrospective analysis,60 patients with hematologic malignancies admitted to the Second Affiliated Hospital of Hainan Medical University from January 2020 to January 2022 and receiving chemotherapy were observed.The patients were divided into study group(infected,n=20)and control group(uninfected group,n=40)according to the incidence of bloodstream infection.mIPS score and T lymphocyte subsets(CD3^(+),CD4^(+),CD4^(+)/CD8^(+))were compared between the two groups before chemotherapy and granulocytosis stage,and receiver operating characteristic curve(ROC)was selected to evaluate the diagnostic efficacy of bloodstream infection.The influencing factors of blood stream infection during chemotherapy of granulocytopenia were analyzed by Logistic multivariate regression.Results At granulocytopenia stage,the mIPS score of 2 groups were significantly higher than those before chemotherapy,and the mIPS score of the study group was(15.28±1.97)points,which were higher than that of the control group[(8.01±1.84)points],the differences were statistically significant(P<0.05).At granulocytic penia stage,the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)of two groups were significantly lower than those before chemotherapy,and the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in the study group were(25.31±3.38)%,(13.63±4.32)%,0.55±0.19,respectively,which were significantly lower than those in the control group[(33.36±4.62)%,(16.47±4.08)%,0.73±0.22],the differences were statistically significant(P<0.05).The results of Receiver operating characteristic analysis showed that the area under the curve(AUC)of mIPS score for predicting blood stream infection during the chemotherapy phase of granulocytosis in hematologic malignancies was 0.819,the AUC of CD3^(+)was 0.696,that of CD4^(+)was 0.693,and that of CD4^(+)/CD8^(+)was 0.747.The AUC of mIPS combined with T lymphocyte subsets was 0.897.Logistic multivariate regression analysis showed that mIPS score was a risk factor for bloodstream infection(P<0.05),and T lymphocyte subsets were a protective factor for bloodstream infection(P<0.05).Conclusion mIPS score combined with T lymphocyte subsets has significant predictive value in the diagnosis of blood stream infection during the chemotherapy phase of granulocytosis in malignant hematologic diseases,and can provide a very favorable reference for the prevention and treatment of blood stream infection.