降钙素原、C反应蛋白和白细胞介素-6在血液病患者血流细菌感染中的诊断意义  

Diagnostic Values of Procalcitonin,C-reactive Protein and Interleukin-6 in Hematological Diseases with Bacterial Infection

作　　者：刘同波[1] 王茂全 关伟[2] 靖彧[2] LIU Tong-Bo;WANG Mao-Quan;GUAN Wei;JING Yu(Department of Computer,General Hospital of Chinese PLA,Beijing 10053,China;Department of Hematology,General Hospital of Chinese PLA,Beijing 10053,China)

机构地区：[1]中国人民解放军总医院计算机室,北京100853 [2]中国人民解放军总医院血液科,北京100853

出　　处：《中国实验血液学杂志》2018年第5期1548-1552,共5页Journal of Experimental Hematology

摘　　要：目的:探讨降钙素原(PCT)、C反应蛋白(CRP)和白细胞介素-6(IL-6)对血液病患者血流细菌感染的临床诊断意义,为血液病患者感染的用药提供依据。方法:选取2014年01月02日至2018年01月27日期间的3631例次送检血培养标本为研究对象,同时检测PCT、CRP和IL-6水平(IL-6送检1587例次),根据检验结果将样本分为血培养阳性组208例和血培养阴性组3423例;血培养阳性组又分为革兰阳性菌感染组34例次与革兰阴性菌感染组174例次。分别对比血培养阳性组与血培养阴性组、革兰阳性组与革兰阴性组的PCT、CRP、IL-6水平,并对例次较多的AML、ALL和NHL患者比较了血培养阳性与阴性组的PCT,CRR和IL-6水平,采用R语言3. 4. 4进行分析。结果:血培养阳性组和阴性组的PCT中位数水平分别为0. 41(0. 04-103. 34)μg/L和0. 20(0. 02-200)μg/L(P <0. 001),CRP中位数水平分别为9. 49(0. 1-370) mg/dl和5. 42(0-370) mg/dl(P <0. 001),IL-6水平中位数分别为186. 1(2. 0-5000) pg/ml和52. 65(1. 5-5000) pg/ml(P <0. 001)。革兰阳性组和革兰阴性组的PCT水平中位数分别为0. 20(0. 05-93. 83)μg/L和中位数0. 58(0. 04-103. 34)μg/L(P=0. 006),CRP水平中位数分别为9. 19(0. 1-35. 3) mg/dl和9. 49(0. 1-370) mg/dl(P=0. 300),IL-6水平中位数分别为83. 01(5. 61-1500) pg/ml和208(2. 0-5000) pg/ml(P=0. 357)。AML、ALL、NHL患者中除ALL的CRP水平之外,其余指标均有统计学差异。结论:血液病患者血流感染者PCT、CRP和IL-6较非血流感染者均显著上升,可作为早期诊断指标;革兰阳性感染者与革兰阴性感染者中PCT水平亦有显著性差异,可作为重要的辅助标准。Objective:To evaluate the diagnostic values of procalcitonin(PCT),C-reactive protein(CRP)and interleukin-6(IL-6)in patients suffered from hematological diseases with bacterial infection,and to provide further evidence for clinical application.Methods:A total of 3631 blood cultures,sernm levels of PCT and CRP and IL-6(n=1587)from the inpatients from 2014-01-02 to 2018-01-27 were retrospectively analyzed.The patients were divided into positive(n=208)and negative blood culture(n=3423)groups.Positive blood culture group were redivided into gram-positive(n=34)andgram-negative(n=174)subgroups.The values CRP,PCT and IL-6 were compared respectively in these groups.The data were analyzed by using R 3.4.4 language.Results:The medians of PCT values in positive and ngative blood culture groups wer^0.41(0.04-103.34)pg/L and 0.20(0.02-200)pg/L(P<0.001)respectively.The medians of CRP values in positive and negative blood culture groups were 9.49(0.1-370)mg/dland5.42(0-370)mg/dl(P<0.001)respectively.The medians of IL-6 values in positive and negative blood culture groups were 186.1(2.0-5000,n=91)pg/ml and 52.65(1.5-5000,n=1496)pg/ml(P<0.001).The medians of PCT values in gram-positive and gram-negative groups were 0.20(0.05-93.83)pg/L and 0.58(0.04-103.34)pg/L(P=0.006)respectively.The medians of CRP value in gram-positive and gram-negative groups were 9.19(0.1-35.3)mg/dL and 9.49(0.1-370)mg/dl(P=0.30)respectively.The medians of IL-6 values in gram-positive and gram?negative groups were 83.01(5.61-1550,n=12)pgml and 208(2.0-5500,n=79)pgml(P=0.357).Conclusion:The PCT,CRP and IL-6 levels were significantly higher in the positive blood culture group than those in thenegative blood culturegroup,so providetheeffectiveearly diagnostic markers for blood 01(11X0.PCT levels in grampositive group were significantly higher than that in gram-negative groups,contributing to distinguish between the 2 groups.

关 键 词：降钙素原 C反应蛋白 白细胞介素-6 血流感染 血培养 血液病 

分 类 号：R733[医药卫生—肿瘤] R378[医药卫生—临床医学]