成人急性髓性白血病患者血清Th1/Th2型细胞因子、PCT、CRP检测及其临床意义

Detection of serum Th1/Th2 cytokines,PCT,and CRP in adult patients with acute myelogenous leukemia and its clinical significance

目的 检测成人急性髓性白血病患者血清辅助性T细胞1/T细胞2(Th1/Th2)型细胞因子、降钙素原(PCT)、C反应蛋白(CRP)水平并探讨其临床意义。方法 选取2021年1月至2023年12月曲靖市第一人民医院收治的98例成人急性髓性白血病感染患者为研究组,按照不同感染程度分为17例脓毒症组与81普通感染组;同期选取98例成人急性髓性白血病无感染患者为非感染组;同期选择98例门诊健康体检者作为对照组。比较研究组、非感染组及对照组的血清白介素-2、干扰素-γ、白介素-4、白介素-10、PCT、CRP水平,比较脓毒症组与普通感染组患者的血清白介素-2、干扰素-γ、白介素-4、白介素-10、PCT、CRP水平,采用受试者工作特征(ROC)曲线分析以上指标对成人急性髓性白血病感染的诊断价值。结果 研究组患者的血清白介素-2、干扰素-γ、PCT、CRP水平分别为(30.27±3.02) pg/mL、(280.16±31.59) pg/mL、(2.57±0.52) ng/mL、(89.42±10.36) mg/L,依次高于非感染组的(13.29±1.42) pg/mL、(229.47±23.15) pg/mL、(0.43±0.06) ng/mL、(13.28±1.54) mg/L和对照组的(6.09±1.26) pg/mL、(150.29±16.58) pg/mL、(0.21±0.03) ng/mL、(7.04±1.40) mg/L,差异均有统计学意义(P<0.05);研究组患者的血清白介素-4、白介素-10分别为(32.39±3.75) pg/m L、(2.96±0.45) pg/m L,依次低于非感染组的(51.03±7.28) pg/m L、(4.21±0.72) pg/m L和对照组的(78.29±10.45) pg/m L、(6.50±0.51) pg/m L,差异均有统计学意义(P<0.05);脓毒症组患者的血清白介素-2、干扰素-γ、PCT、CRP水平分别为(45.93±8.15) pg/m L、(340.17±40.21) pg/m L、(6.95±1.28) ng/m L、(134.73±12.81) mg/L,明显高于普通感染组的(26.98±2.57) pg/mL、(267.57±29.78) pg/mL、(1.65±0.36) ng/mL、(79.91±9.85) mg/L,差异均有统计学意义(P<0.05);脓毒症组患者的血清白介素-4、白介素-10水平分别为(18.87±1.65) pg/mL、(1.29±0.31) pg/mL,明显低于普通感染组的(35.88±4.19) pg/mL、(3.31±0.48) pg/mL,差异均有统计学意义(P<0.05);ROC曲线分析结果显示,白介素-2、干扰素-γ、白介素-4、白介素-10、PCT、CRP单独及联合检测对成人急性髓性白血病感染诊断的曲线下面积(AUC)分别为0.817、0.789、0.798、0.827、0.786、0.766、0.962,联合检测的AUC大于各指标单独检测。结论 成人急性白血病感染患者Th1细胞因子、PCT及CRP水平明显上升,Th2细胞因子水平明显下降,临床通过检测血清Th1/Th2细胞因子、PCT、CRP水平能够辅助成人急性髓性白血病感染的早期诊断,值得推广。

Objective To detect the levels of T helper cell 1/T helper cell 2(Th1/Th2)cytokines,procalcitonin(PCT),and C-reactive protein(CRP)in adult patients with acute myelogenous leukemia and to explore their clinical significance.Methods Ninety-eight adult patients with acute leukemia admitted to Qujing First People's Hospital from January 2021 to December 2023 were selected as the study group,which were divided into sepsis subgroup(n=17)and common infection subgroup(n=81)according to different infection degrees;at the same time,98 adult acute myelogenous leukemia patients without infection were selected as non-infection group;ninety-eight outpatients undergoing physical examination were selected as the control group.The levels of serum interleukin-2,interferon-γ,interleukin-4,interleukin-10,PCT,and CRP in the study group,non-infection group,and control group were compared,and the levels of serum interleukin-2,interferon-γ,interleukin-4,interleukin-10,PCT,and CRP in sepsis subgroup and common infection subgroup were compared.The effects of the above indexes on acute myelogenous leukemia were analyzed by receiver operating characteristic(ROC)curve.Results The levels of serum interleukin-2,interferon-γ,PCT,and CRP in the study group were(30.27±3.02)pg/mL,(280.16±31.59)pg/mL,(2.57±0.52)ng/mL,and(89.42±10.36)mg/L,which were significantly higher than(13.29±1.42)pg/mL,(229.47±23.15)pg/mL,(0.43±0.06)ng/mL,and(13.28±1.54)mg/L in the non-infection group and(6.09±1.26)pg/mL,(150.29±16.58)pg/mL,(0.21±0.03)ng/mL,and(7.04±1.40)mg/L in the control group,with statistically significant differences(P<0.05).The levels of serum interleukin-4 and interleukin-10 in the study group were (32.39±3.75) pg/mL and (2.96±0.45) pg/mL, which were significantly lower than (51.03±7.28) pg/mL and (4.21±0.72) pg/mL in the non-infection group and (78.29±10.45) pg/mL and (6.50±0.51) pg/mL in the control group, with statistically significant differences (P<0.05). The levels of serum interleukin-2, interferon-γ, PCT, and CRP in sepsis subgroup were (45.93±8.15) pg/mL, (340.17±40.21) pg/mL, (6.95±1.28) ng/mL, and (134.73±12.81) mg/L, which were sig-nificantly higher than (26.98±2.57) pg/mL, (267.57±29.78) pg/mL, (1.65±0.36) ng/mL, and (79.91±9.85) mg/L in com-mon infection subgroup (P<0.05). The levels of serum interleukin-4 and interleukin-10 in sepsis subgroup were (18.87± 1.65) pg/mL and (1.29±0.31) pg/mL, which were significantly lower than (35.88±4.19) pg/mL and (3.31±0.48) pg/mL in common infection subgroup (P<0.05). ROC curve analysis showed that the area under the curve (AUC) of interleukin-2, interferon-γ, interleukin-4, interleukin-10, PCT, and CRP alone for diagnosing acute myelogenous leukemia with infec-tion were 0.817, 0.789, 0.798, 0.827, 0.786, 0.766, significantly smaller than 0.962 of combined detection of the six in-dexes. Conclusion The levels of Th1 cytokine, PCT, and CRP in adult patients of acute myelogenous leukemia with in-fection were significantly increased, while the levels of Th2 cytokine were significantly decreased. Clinical detection of serum Th1/Th2 cytokine, PCT, and CRP levels can assist the early diagnosis of adult acute leukemia with infection, which is worthy of promotion.