白血病感染患者细胞损伤及凝血标记物和炎症因子水平变化  

Changes of endothelial cell damage,coagulation markers and inflammatory factors in leukemia patients with infection

作　　者：曹福英 张春霞 王舒莉 付彬[1] 桑玉旗[1] CAO Fu-ying;ZHANG Chun-xia;WANG Shu-li;FU Bin;SANG Yu-qi(Heze Municipal Hospital,Heze,Shandong 274000,China)

机构地区：[1]菏泽市立医院血液科,山东菏泽274000

出　　处：《中华医院感染学杂志》2020年第10期1527-1531,共5页Chinese Journal of Nosocomiology

基　　金：山东省科研基金资助项目(2017102)。

摘　　要：目的探讨分析白血病合并感染患者的内皮细胞损伤标记物、炎症因子及凝血标记物水平及其与感染严重程度的相关性。方法选择2016年3月-2018年12月菏泽市立医院血液科收治的急性白血病患者137例,根据患者是否发生医院感染分为未感染组58例、普通感染组37例以及脓毒症组42例,检测患者内皮损伤标记物血管性血友病因子(vWF),炎症因子白细胞介素-6(IL-6)、降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)以及凝血指标凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体,分析各指标在不同感染患者中的变化情况及其相关性。结果脓毒症组血清IL-6、PCT以及hs-CRP水平分别为(138.42±35.29)ng/L、(6.15±2.21)ng/ml、(153.28±41.02)mg/L均显著高于普通感染组与未感染组(P<0.05),而普通感染组患者上述指标水平均显著高于未感染组(P<0.05)。三组患者vWF水平比较差异有统计学意义(F=15.201,P<0.001)。脓毒症组PT、APTT、D-二聚体水平分别为(14.28±1.73)s、(40.33±5.42)s、(4.32±1.28)mg/L均显著高于普通感染组与未感染组(P<0.05),普通感染组高于未感染组(P<0.05)。凝血标记物PT、APTT、D-二聚体和内皮细胞损伤标记物vWF与炎症因子IL-6、PCT、hs-CRP均呈显著正相关关系(P<0.05)。结论急性白血病感染患者随着感染严重程度的增加,机体炎症反应、凝血激活以及内皮细胞损伤明显增强,三者之间相互影响互相促进,其中炎症因子血清PCT、IL-6以及hs-CRP对急性白血病患者脓毒症发生具有着潜在的临床诊断价值,可作为临床诊断辅助指标。OBJECTIVE To explore the correlation between endothelial cell damage markers,coagulation markers,inflammatory factors and severity of infection in the leukemia patients complicated with infection.METHODS A total of 137 patients with acute leukemia who were treated in hematology department of Heze Municipal Hospital from Mar 2016 to Dec 2018 were enrolled in the study group and divided into the non-infection group with 58 cases,the common infection group with 37 cases and the sepsis group with 42 cases according to the status of nosocomial infection.The endothelial cell damage marker Von Willebrand factor(vWF),inflammatory factors interleukin-6(IL-6),procalcitonin(PCT)and high-sensitivity C-reactive protein(hs-CRP)as well as coagulation indexes prothrombin time(PT),activated partial thromboplastin time(APTT)and D-dimer of the patients were detected,and the changes of the indexes of the three groups of patients and their correlation were observed.RESULTS The levels of serum IL-6,PCT and hs-CRP of the sepsis group were respectively(138.42±35.29)ng/L,(6.15±2.21)ng/ml and(153.28±41.02)mg/L,significantly higher than those of the common infection group and the non-infection group(P<0.05),the levels of above indexes of the common infection group were significantly higher than those of the non-infection group(P<0.05).There was significant difference in the vWF level among the three groups of patients(F=15.201,P<0.001).The levels of PT,APTT and D-dimer of the sepsis group were respectively(14.28±1.73)s,(40.33±5.42)s and(4.32±1.28)mg/L,significantly higher than those of the common infection group and the non-infection group(P<0.05),and the levels of above indexes of the common infection group were significantly higher than those of the non-infection group(P<0.05).The coagulation markers PT,APTT,D-dimer and endothelial cell damage marker vWF were positively correlated with the inflammatory factors IL-6,PCT and hs-CRP(P<0.05).CONCLUSION With the increase of the severity of infection,the inflammatory reaction,coagulation

关 键 词：白血病 感染 内皮细胞损伤标记物 炎症因子 凝血标记物 

分 类 号：R733.71[医药卫生—肿瘤]