降钙素原监测与血液病合并感染患者的临床相关性分析  

Clinical significance of procalcitonin monitoring in the hematological patients complicated with infection

作　　者：郑佳佳[1] 孙爱宁[1] 张彤彤[1] 陈苏宁[1] 常伟荣[1] 张险峰[1] 吴德沛[1] 

机构地区：[1]苏州大学附属第一医院血液内科,江苏省血液研究所,卫生部血栓与止血重点实验室,血液学协同创新中心,江苏苏州215006

出　　处：《中国感染与化疗杂志》2016年第4期419-423,共5页Chinese Journal of Infection and Chemotherapy

基　　金：江苏省卫生公益性行业科研专项(201202017);国家高技术研究发展计划(863计划)(2012AA02A505);江苏省科教兴卫工程-临床医学中心(ZX201102);江苏省自然科学基金(BK20131168);苏州市自然基金(20113201110010)

摘　　要：目的探讨降钙素原(PCT)定量检测及监测其动态变化在血液病化疗及移植相关感染患者中的临床应用价值。方法收集并回顾性分析苏州大学附属第一医院血液科497例血清PCT阳性(>0.5μg/L)的血液病患者的临床资料,比较PCT水平在感染性休克、血流感染及不同菌种之间的差异。应用受试者工作特征曲线(ROC曲线)进行评价,明确PCT在血流感染中的诊断价值。检测患者第一次发热时、使用抗菌药物治疗后第3、7、14、21、28天血清PCT水平,比较感染控制组和感染迁延组及感染恶化组间PCT的变化规律以及PCT变化在预测感染控制中的作用。结果 497例PCT阳性患者中421例(84.7%,421/497)为实验室或临床确诊感染,其中发热24 h内PCT即阳性的有296例(70.3%,296/421);发生感染性休克(14.0%,59/421)和未发生感染性休克(86.0%,362/421)患者PCT中位值分别为6.29μg/L和1.16μg/L,两者PCT值差异有统计学意义(P<0.01);421例感染患者中有408例同时行血培养检查,其中血培养阳性167例(40.9%,167/408),血培养阴性240例(58.8%,240/408),1例曲霉污染,两组PCT中位值分别为2.47μg/L、1.15μg/L,差异有统计学意义(P<0.01)。167例血培养阳性患者中,革兰阴性菌感染(64.7%,108/167)和革兰阳性菌感染(22.2%,37/167)患者PCT中位值分别为4.32μg/L和1.39μg/L,差异具有统计学意义(P<0.01)。PCT诊断血流感染的曲线下面积(AUC)是0.670,PCT取2.05μg/L为截点时诊断性能最高,其灵敏度、特异度分别为54.3%,70.0%。289例动态监测抗感染治疗后的PCT水平患者中感染控制组192例,感染迁延组71例,感染恶化组26例,3组在抗感染治疗后前3 d的PCT水平无差异,但3 d后PCT水平差异显著。结论 PCT可作为感染尤其血培养阴性感染发热患者较优的快速辅助实验室诊断指标之一,其动态变化对判断感染控制情况及抗菌药物使用均具有重要的指导意义。Objective To evaluate the clinical value of procalcitonin （PCT） measurement and its dynamic monitoring in the hematological patients complicated with infection while undergoing chemotherapy or transplant. Methods The clinical data were collected and analyzed retrospectively in 497 hematological patients with serum PCT above 0.5 gg/L. The procalcitonin level was compared between the patients with septic shock and those without, between the patients with positive blood culture and those with negative blood culture, and between the patients with gram-positive bloodstream infection and those with gram-negative bloodstream infection.Receiver operating characteristic curve was used to evaluate the diagnostic value of procalcitonin in predicting sepsis. PCT values were collected at the onset of fever and 3, 7, 14, 21, and 28 days after antimicrobial therapy. The dynamic change of PCT after operation was compared between the patients whose infection was successfully controlled and those without adequate control. Results Of the 497 hematological patients with serum PCT value 〉 0.5 μg/L, 421 （84.7 %, 421/497） were diagnosed with infection based on clinical symptoms and microbiological testing. PCT value increased （〉0.5 μg/L） within 24 hours after fever onset in 296 （70.3 %, 296/421） patients. The median and range of procalcitonin level （6.29, 0.505-100, μg/L） were significantly higher in 59 （14.0%, 59/421） patients with septic shock than in those （86.0%, 362/421） without （1.16, 0.502-100,μg/L, Z =-7.726, P〈0.01）. Of the 408 patients receiving blood culture, the median and range of procalcitonin level was significantly higher in the 167 patients （2.47, 0.508-100, μg/L） with positive blood culture than in the 240 patients with negative blood culture （1.15, 0.501-100,μg/L, Z = -5.762, P〈0.01）. Additionally, the median and range ofprocalcitonin level was significantly higher in the 108 （64.7%, 108/167） patients with gram-negative sepsis （4.32, 0.508-100,μg/L） than

关 键 词：降钙素原 血液病 血培养 感染 

分 类 号：R55[医药卫生—血液循环系统疾病]