炎症因子、凝血指标和内皮细胞损伤标记物在恶性血液病脓毒症早期诊断中的应用  

Application of Inflammatory Factor,Coagulation Index and Endothelial Cell Injury Markers in the Early Diagnosis of Malignant Hematologic Diseases with Sepsis

作　　者：于佳 陈淘江 王冬梅 兰蕴平[3] 王国祥 Yu Jia;Chen Taojiang;Wang Dongmei;Lan Yunping;Wang Guoxiang(Department of Critical Care Medicine, Chengdu Fifth People * s Hospital, Chengdu 611130, Sichuan, China;Department of Hematology, Rheumatology and Immunology, Chengdu Fifth People,s Hospital, Chengdu 611130, Sichuan, China;Department of Critical Care Medicine, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine,University of Electronic Science and Technology of China, Chengdu 610041, Sichuan, China)

机构地区：[1]成都中医药大学第二临床医学院·成都市第五人民医院重症医学科,成都611130 [2]成都中医药大学第二临床医学院·成都市第五人民医院血液风湿免疫科,成都611130 [3]四川省医学科学院·四川省人民医院重症医学科,成都610072

出　　处：《肿瘤预防与治疗》2019年第8期688-693,共6页Journal of Cancer Control And Treatment

基　　金：四川省卫计委科研课题(编号:17PJ137)~~

摘　　要：目的:探讨炎症因子、凝血指标、内皮细胞损伤标记物在恶性血液病脓毒症患者早期诊断中的应用。方法:选取成都市第五人民医院2014年1月至2018年12月确诊并收治入院的恶性血液病患者225例,进一步按照感染程度分为脓毒症组(77例)、普通感染组(63例)和未感染组(85例),分别检测三组患者的炎症指标、凝血指标和内皮细胞损伤标记物水平,比较其在三组患者之间的差异及三者的关系,并应用接受者操作特征(receiver operating characteristic,ROC)曲线评价降钙素(procalcitonin,PCT)、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、白细胞介素6(interleukin-6,IL-6)、CD64阳性率对脓毒症的诊断效能。结果:三组恶性血液病患者的年龄、体温、红细胞计数(red blood cell count,RBC)、血红蛋白(hemoglobin,Hb)之间差异有统计学意义(均P <0. 05),进一步与未感染组相比,脓毒症组和普通感染组的平均年龄更大,RBC、Hb水平明显降低,而脓毒症组患者体温明显高于普通感染和未感染组。与未感染组相比,脓毒症组和普通感染组炎症指标(hs-CRP、PCT、IL-6、CD64)显著升高,与普通感染组相比,脓毒症组的炎症指标水平进一步升高。与未感染组相比,脓毒症组和普通感染组的凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplatin time,APTT)、D-二聚体、血管性血友病因子(von widebrand facror,VWF)水平均显著升高,而抗凝血酶Ⅲ(anti-thrombinⅢ,AT-Ⅲ)水平显著降低;与普通感染组相比,脓毒症组的PT、APTT、D-二聚体、VWF水平升高更明显,而AT-Ⅲ水平降低更显著。应用ROC曲线检验hs-CRP、PCT、IL-6、CD64早期诊断恶性血液病脓毒症的临床价值,结果发现,CD64的检验效能最高曲线下面积为0. 998,灵敏度为99. 2%、特异度为98. 9%。结论:hs-CRP、PCT、IL-6、CD64炎症指标可为恶性血液病合并感染患者的早期诊断提供参考,�Objective: To discuss the application of inflammatory factor,coagulation index and endothelial cell injury markers in the early diagnosis of malignant hematologic diseases with sepsis. Methods: A total of 225 patients with malignant hematologic diseases diagnosed and admitted to Chengdu Fifth People’s Hospital from January 2014 to December 2018 were further assigned to the sepsis group(77 cases),the infection group(63 cases) and the noninfection group(85 cases).Inflammatory index,coagulation index and endothelial cell injury markers in the three groups were detected,and differences among the three groups were compared. Receiver operating characteristic(ROC) curve was used to evaluate the diagnostic efficacy of procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6) and the positive rate of CD64 for sepsis. Results: There were significant differences in patients ’age,body temperature,red blood cell count(RBC) and hemoglobin(Hb) among the three groups(P < 0. 05). Compared to the noninfection group,average age in the sepsis group and the infection group were older,and RBC and Hb level were significantly lower,while temperature in the sepsis group was significantly higher than that in the infection group and the noninfection group. Compared to the noninfection group,inflammatory indexes(hs-CRP,PCT,IL-6,CD64) in the sepsis group and the infection group were significantly higher,and inflammatory indexes in the sepsis group were higher than those in the infection group. Compared to the noninfection group,prothrombin time(PT),activated partial thromboplatin time(APTT),D-dimer and von Willebrand factor(VWF) level in the sepsis group and the infection group were significantly higher,while antithrombin Ⅲ(AT-III) level was significantly lower. Compared to the infection group,PT,APTT,D-dimer and VWF level in the sepsis group were significantly higher,while AT-III level was significantly lower. ROC curve was used to test the clinical value of hs-CRP,PCT,IL-6 and CD64 in early diagnosis of maligna

关 键 词：脓毒症 恶性血液病 炎症因子 凝血指标 内皮细胞损伤 

分 类 号：R733.7[医药卫生—肿瘤]