分析CRP、PCT、LPS及Zonulin水平对急性白血病患者化疗后肠道感染的预测价值

Predictive Value of CRP,PCT,LPS and Zonulin Levels in Intestinal Infection after Chemotherapy in Patients with Acute Leukemia

目的分析C反应蛋白(CRP)、降钙素原(PCT)、脂多糖(LPS)及Zonulin水平对急性白血病患者化疗后肠道感染的预测价值。方法选取2020年01月至2024年01月河南省人民医院收治的60例急性白血病患者作为研究对象,均接受单次或多次化疗,根据是否合并肠道感染分为感染组(30例)和非感染组(30例),感染组根据中性粒细胞计数水平分为中性粒细胞缺乏组(中性粒细胞计数<0.5*109/L)和非中性粒细胞缺乏组(中性粒细胞计数≥0.5*109/L),分别为15例和15例。比较各组血清CRP、PCT、LPS及Zonulin水平;通过相关分析(Spearman)对感染组PCT、CRP、LPS及Zonulin浓度水平的相关性予以分析;急性白血病患者化疗后肠道感染的诊断价值则通过受试者工作特征(ROC)曲线评估。结果肠道感染组和中性粒细胞缺乏组CRP、PCT、LPS及Zonulin水平明显高于非肠道感染组及非中性粒细胞缺乏组(P<0.05)。相关分析(Spearman)结果可以观察到,感染组外周血里面的PCT与CRP、LPS及Zonulin浓度水平呈正相关(r=0.26、0.41、0.46、0.49,P<0.001)。CRP、PCT、LPS及Zonulin水平联合诊断急性白血病化疗后合并肠道感染的曲线下面积(AUC)为0.927(95%CI:0.864~0.990),灵敏度为93.3%,特异度为80%。结论急性白血病化疗后合并肠道感染患者CRP、PCT、LPS及Zonulin水平明显高于非感染者,上述4项指标联合检测对患者有一定的预测价值。

Objective To analyze the predictive value of C-reactive protein(CRP),procalcitonin(PCT),lipopolysaccharide(LPS)and Zonulin levels on intestinal infection in patients with acute leukemia after chemotherapy.Methods A total of 60 patients with acute leukemia admitted to Henan Provincial People′s Hospital from January 2020 to January 2024 were selected as study subjects,all of whom received single or multiple chemotherapy.They were divided into infected group(30 cases)and non-infected group(30 cases)according to whether they had intestinal infection.The infection group was divided into neutrophilic deficiency group(neutrophilic count<0.5*109/L)and non-neutrophilic deficiency group(neutrophilic count≥0.5*109/L)according to the level of neutrophilic count,15 cases and 15 cases respectively.Serum levels of CRP,PCT,LPS and Zonulin were compared among all groups.The correlation of PCT,CRP,LPS and Zonulin concentrations in the infected group was analyzed by Spearman analysis.The diagnostic value of acute leukemia after chemotherapy alone or in combination was evaluated by receiver operating characteristic(ROC)curve.Results The levels of CRP,PCT,LPS and Zonulin in enteric infection group and neutrophil deficiency group were significantly higher than those in parenteral infection group and non-neutrophil deficiency group(P<0.05).Spearman analysis showed that PCT was positively correlated with CRP,LPS and Zonulin concentrations in the infected group(r=0.26,0.41,0.46,0.49,P<0.001).The area under the curve(AUC)of CRP,PCT,LPS and Zonulin in patients with intestinal infection after chemotherapy was 0.927(95%CI:0.864-0.990),the sensitivity was 93.3%,and the specificity was 80%.Conclusions The levels of CRP,PCT,LPS and Zonulin in patients with intestinal infection after chemotherapy were significantly higher than those of non-infected patients.The combined detection of these four indexes has certain predictive value for patients.