白血病合并感染患者病原学特点及炎症因子的诊断价值分析

Etiological characteristics of leukemia patients complicated with infection and diagnostic value of inflammatory factors

目的探讨白血病合并感染患者病原菌分布及CD_(64)感染指数、C-反应蛋白(CRP)、降钙素原(PCT)和中性粒细胞百分比(NEU%)的诊断价值。方法选择2016年1月-2017年12月在医院进行治疗的白血病合并细菌感染患者45例(感染组),白血病未合并细菌感染患者45例(对照组),ROC曲线分析CD_(64)感染指数、CRP、PCT和NEU%指标水平预测感染的诊断价值。采集感染患者临床标本,应用全自动微生物分析仪进行病原菌培养与鉴定。结果感染组患者CD_(64)感染指数、CRP、PCT、NEU%水平均高于对照组(P<0.05);ROC曲线结果表明,CD_(64)感染指数、CRP、PCT、NEU%对白血病合并细菌感染的最佳截断值分别为68.94、1.56(ng/ml)、2.63(ng/ml)、74.17%,约登指数分别为77.78%、37.78%、71.11%、57.78%;采集感染患者血液,尿液等临床标本进行细菌培养,共分离出合格菌株58株,革兰阴性菌44株,占75.86%,革兰阳性菌11株,占18.97%,其中大肠埃希菌15株,占25.86%。结论 CD_(64)感染指数对于白血病合并细菌感染的患者具有良好的诊断价值,但是在实际临床工作中,还需要从患者的实际情况出发,进行综合考虑。白血病患者合并细菌感染以革兰阴性菌为主,需要在治疗中给予重视。

OBJECTIVE To explore the distribution of pathogens isolated from the leukemia patients complicated with infection and analyze the diagnostic value of CD64 infection index,C-reactive protein(CRP),procalcitonin(PCT)and neutrophil percentage(NEU%).METHODS Totally 45 leukemia patients who were complicated with bacterial infection and treated in the hospital from Jan 2016 to Dec 2017 were chosen as the infection group,and 45 leukemia patients who were not complicated with bacterial infection were set as the control group.ROC curve was employed to analyze the diagnostic value of CD64 infection index,CRP,PCT and NEU%.The clinical specimens were collected from the patients with the infection,and the pathogens were isolated and identified by using automatic microorganism analyzer.RESULTS The CD64 infection index,CRP,PCT and NEU%of the infection group were significantly higher than those of the control group(P<0.05).The ROC curve analysis showed that the optimal cutoff values of the CD64 infection index,CRP,PCT and NEU%were respectively 68.94,1.56(ng/ml),2.63(ng/ml)and 74.17%in diagnosis of the leukemia patients complicated with bacterial infection,and the Youden indexes were 77.78%,37.78%,71.11%and 57.78%,respectively.A total of 58 strains of qualified pathogens were isolated from the blood and urine specimens of the patients with infection,44(75.86%)of which were gram-negative bacteria,and 11(18.97%)were gram-positive bacteria;Escherichia coli accounted for 25.86%(15 strains).CONCLUSIONThe CD64 infection index has high value in diagnosis of the leukemia patients complicated with bacterial infection,however,it is necessary to take comprehensive considerations in clinical practice by starting from the actual situation of the patients.The gram-negative bacteria are dominant among the pathogens isolated from the leukemia patients complicated with bacterial infection,which should be attached great importance to during the treatment.