移植日C反应蛋白水平对异基因造血干细胞移植早期感染及预后的预测意义  

Value of C-reactive protein level on transplantation day in predicting early post-transplant infections and outcomes of allogeneic hematopoietic stem cell transplantation

作　　者：沈克锋[1,2] 刘启发[2] 孙竞[2] 江千里[2] 张钰[2] 周红升[2] 戴敏[2] 肖敏[1] 王瑾[1] 罗莉[1] 李钦璐[1] 安海云[1] 洪振亚[1] 孟力[1] 杨默[2] 周剑峰[1] 王高翔[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院血液内科,湖北武汉430030 [2]南方医科大学南方医院血液内科,广东广州510515

出　　处：《南方医科大学学报》2015年第11期1535-1539,共5页Journal of Southern Medical University

基　　金：国家自然科学基金(81200382)~~

摘　　要：目的探讨移植日C反应蛋白（CRP）水平对异基因造血干细胞移植早期败血症等感染事件发生的预测意义。方法回顾性分析78例异基因移植患者病例资料,采用受试者工作特征曲线（ROC）评估CRP诊断移植早期败血症的临床参考值及相应灵敏度和特异度,以所得临床参考值为临界值将病例资料分为低CRP组和高CRP组,分析比较两组间的移植相关并发症及总生存（OS）和复发率等。结果 CRP诊断移植早期败血症的临床参考值为23.3 mg/L（AUC=0.735,P=0.001,95%CI0.623~0.848）,相应灵敏度和特异度分别为0.793和0.592;高CRP组粒系平均重建时间较低CRP组延迟0.71 d（P=0.237）,巨核系平均重建时间显著延迟4.09 d（P=0.048）;高CRP组移植早期败血症及巨细胞病毒（CMV）血症发生率较低CRP组显著增高（53.5%vs 17.1%,P=0.001;72.1%vs 37.1%,P=0.003）,但两组间EB病毒（EBV）血症、肺部侵袭性真菌感染及急性移植物抗宿主病（a GVHD）发生率无统计学差异（41.9%vs 22.9%,P=0.094;14.0%vs 5.7%,P=0.285,51.2%vs 45.7,P=0.656）;高CRP组中位随访318（7~773）d,低CRP组中位随访299（78~747）d,高CRP组2年OS率较低CRP组显著降低（42.5%vs78.4%,P=0.022）,高CRP组2年累计复发率较低CRP组高（52.3%vs 19.8%,P=0.235）,但差异无统计学意义;Logistic多因素分析显示高CRP水平是移植早期败血症的独立危险因素（OR=5.090,95%CI 1.115~23.229,P=0.036）。结论移植日CRP水平对异基因造血干细胞移植早期败血症有一定的预测意义,高CRP水平提示较高的移植早期败血症和CMV血症发生率以及较差的预后。Objective To investigate the value of C-reactive protein（CRP） on transplantation day in predicting early post-transplant infections and outcomes of allogeneic hematopoietic stem cell transplantation（allo-HSCT）. Methods We retrospectively analyzed the clinical data of 78 recipients undergoing allo-HSCT. The clinical reference value of CRP on transplantation day was determined, and its sensitivity and specificity for diagnosing bacteremia was analyzed using receiver-operating characteristic curve（ROC）. The incidence of transplant-related complications, overall survival, and relapse rate of the patients were analyzed with respect to the CRP level. Results The clinical reference value of CRP for diagnosing bacteremia was 23.3 mg/L（AUC=0.735 [95% CI： 0.623-0.848], P=0.001）, which had a diagnostic sensitivity and specificity of0.793 and 0.592, respectively. Compared with the patients with low CRP levels, the patients with high CRP levels tended to have delayed neutrophil reconstitution and platelet engraftment by 0.71 days（P=0.237） and 4.09 days（P=0.048）, respectively,and had a significantly higher incidence of bacteremia（17.1% vs 53.5%, P=0.001） and CMV viremia（37.1% vs 72.1%, P=0.003）within 100 days following the transplantation; the incidences of EBV viremia, pulmonary invasive fungal infection, or acute graft versus host disease（a GVHD） showed no significant difference between the two groups（41.9% vs 22.9%, P=0.094; 14.0% vs5.7%, P=0.285; 51.2% vs 45.7, P=0.656, respectively）. During the follow-up for a median of 318（7-773） days in high-CRP group and for 299（78-747） days in low-CRP group, the high-CRP group showed a significantly lower 2-year overall survival than the low-CRP group（42.5% vs 78.4%, P=0.022）, and tended to have a higher 2-year cumulative relapse rate（52.3% vs 19.8%, P=0.235）. Logistic multivariate analysis identified a high CRP level on transplantation day as the independent risk factor for post-transplant bacteremia within 100 days（OR=5.090

关 键 词：C反应蛋白 异基因造血干细胞移植 败血症 预后 

分 类 号：R457.7[医药卫生—治疗学]