急性髓系白血病患者化疗后感染FcγRⅡA基因多态性及血清CD64和HNL与PDW的预测价值

FcγRⅡA gene polymorphism in acute myeloid leukemia patients with post-chemotherapy infection and the predictive value of serum CD64,HNL and PDW

目的探讨急性髓系白血病(AML)患者化疗后感染Fcγ受体ⅡA(FcγRⅡA)基因多态性及血清CD64、中性粒细胞载脂蛋白(HNL)、血小板分布宽度(PDW)的预测价值。方法选取2020年10月-2023年10月青岛市中医院收治的AML化疗患者161例,根据化疗后感染情况分为感染组(62例)和未感染组(99例);统计AML患者化疗后感染的病原菌;检测血清CD64、HNL、PDW水平;比较两组血清CD64、HNL、PDW水平及其对AML患者化疗后感染的诊断价值;采用限制性片段长度多态性聚合酶链反应(PCR-RFLP)检测两组患者FcγRⅡA基因多态性。结果AML化疗后感染患者共培养分离病原菌71株,其中革兰阴性菌44株,革兰阳性菌21株,真菌6株,以大肠埃希菌、肺炎克雷伯菌和表皮葡萄球菌为主;感染组血清CD64、HNL和PDW分别为(80.65±26.22)%、(90.52±30.16)ng/ml和(12.39±4.10)%高于未感染组(P<0.05);CD64、HNL、PDW及其联合检测诊断AML患者化疗后感染的曲线下面积(AUC)分别为0.770、0.733、0.773和0.935;联合诊断的AUC高于各项单独检测(P<0.05);感染组FcγRⅡA基因R131位点GG基因型、G等位基因频率分别为41.94%、62.10%高于未感染组,AA基因型和A等位基因频率分别为17.74%、37.90%低于未感染组(P<0.05)。结论AML患者化疗后感染多为革兰阴性菌,且化疗后感染发生后CD64、HNL、PDW呈高表达,联合检测CD64、HNL、PDW有助于诊断AML患者化疗后感染;FcRIⅡIA基因多态性可能参与AML患者化疗后感染。

OBJECTIVE To investigate the FcγreceptorⅡA(FcγRⅡA)gene polymorphism in acute myeloid leu-kemia(AML)patients with post-chemotherapy infection and the predictive value of serum CD64,neutrophil apolipoprotein(HNL)and platelet distribution width(PDW).METHODS A total of 161 AML patients admitted to Qingdao Hospital of Traditional Chinese Medicine from Oct.2020 to Oct.2023 were selected and divided into infected group(62 cases)and uninfected group(99 cases)according to the infection status after chemotherapy.The pathogenic bacteria of post-chemotherapy infection in AML patients were analyzed.Serum levels of CD64,HNL and PDW were detected.The serum levels of CD64,HNL and PDW,as well as their diagnostic value of postchemotherapy infections in AML patients,were compared between the two groups.FcγRⅡa gene polymorphism in the two groups was detected by restriction fragment length polymorphism polymerase chain reaction(PCRRFLP).RESULTS A total of 71 strains of pathogenic bacteria were co-cultured from AML patient with post-chemotherapy infection,including 44 stains of gram-negative bacteria,21 strain s of gram-positive bacteria,and 6 strains of fungal,with Escherichia coli,Klebsiella pneumoniae,and Staphylococcus epidermidis predominating.The serum levels of CD64,HNL,and PDW in the infected group were(80.65±26.22)%,(90.52±30.16)ng/ml,and(12.39±4.10)%,respectively,higher than those in the uninfected group(P<0.05).The area under the curve(AUC)of CD64,HNL,PDW and their combined detection for the diagnosis of post-chemotherapy infection in AML patients were 0.770,0.733,0.773 and 0.935,respectively.The AUC of the combined detection was higher than that of single detection(P<0.05).The frequencies of GG genotype and G allele at R131 locus of FcγRⅡA gene in the infected group were 41.94% and 62.10%,respectively,higher than those in the uninfected group,while the frequencies of AA genotype and A allele were 17.74% and 37.90%,respectively,lower than those in the uninfected group(P<0.05).CONCLUSIONS Post-chemotherapy infections in AML patients after chemotherapy were mostly gram-negative bacteria,and CD64,HNL and PDW were highly expressed after the occurrence of post-chemotherapy infections,and the combined detection of CD64,HNL and PDW was helpful in the diagnosis of post-chemotherapy infections in AML patients.The polymorphism of the FcγRⅡA gene might be involved in the post-chemotherapy infections in AML patients.