mIPS评分联合T淋巴细胞亚群对恶性血液病化疗粒细胞缺乏期并发血流感染的预测价值  

The predictive value of mIPS score combined with T lymphocyte subsets for bloodstream infection during the agranulocytosis stage of chemotherapy for malignant hematological diseases

作　　者：武坤[1,2,3] 贺振新 单建芝[4,5] 程沈菊 李艳红 罗珊 聂波[4,5] WU Kun;HE Zhenxin;SHAN Jianzhi;CHENG Shenju;LI Yanhong;LUO Shan;NIE Bo(Department of Clinical Laboratory,the First Affiliated Hospital of Kunming Medical University,Yunnan,Kunming 650032,China;Yunnan Provincial Key Laboratory of Laboratory Medicine,Yunnan,Kunming 650032,China;Provincial Innovation Team of Clinical Laboratory Diagnosis,Yunnan,Kunming 650032,China;Department of Hematology,the First Affiliated Hospital of Kunming Medical University,Kunming,Yunnan 650032,China;Yunnan Research Center for Hematology,Yunnan,Kunming 650032,China)

机构地区：[1]昆明医科大学第一附属医院医学检验科,云南昆明650032 [2]云南省检验医学重点实验室,云南昆明650032 [3]临床检验诊断省创新团队,云南昆明650032 [4]昆明医科大学第一附属医院血液科,云南昆明650032 [5]云南省血液病研究中心,云南昆明650032

出　　处：《国际检验医学杂志》2021年第23期2905-2909,共5页International Journal of Laboratory Medicine

基　　金：云南省科技厅科技计划项目(2018FE001-200)。

摘　　要：目的探究改良后的感染可能性评分(mIPS评分)联合T淋巴细胞亚群对恶性血液病化疗粒细胞缺乏期并发血流感染的预测价值。方法选取2018年4月至2020年11月昆明医科大学第一附属医院血液科收治的100例首发恶性血液病且行化疗的成年(≥18岁)患者作为研究对象,根据血流感染结局分为感染组(33例)和非感染组(67例)。收集患者一般资料及化疗前、粒细胞缺乏期mIPS评分及T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))等指标并分析其变化。采用受试者工作特征曲线(ROC曲线)评估血流感染的预测价值,采用Logistic多因素回归分析恶性血液病化疗粒细胞缺乏期并发血流感染的影响因素。结果两组患者粒细胞缺乏期mIPS评分与化疗前比较明显增加,且感染组高于非感染组,差异均有统计学意义(P<0.05);两组患者粒细胞缺乏期CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)与化疗前比较均明显降低,且感染组低于非感染组,差异均有统计学意义(P<0.05)。mIPS评分联合T淋巴细胞亚群对恶性血液病化疗粒细胞缺乏期并发血流感染的预测能力最佳,ROC曲线下面积(AUC)为0.898,mIPS评分、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)单项指标的AUC分别为0.820、0.697、0.694、0.748,且Logistic多因素回归分析结果显示,mIPS评分为恶性血液病化疗粒细胞缺乏期并发血流感染的独立危险因素,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)为保护因素。结论mIPS评分联合T淋巴细胞亚群对恶性血液病化疗粒细胞缺乏期并发血流感染有较好的预测价值,可为后续血流感染预防用药提供依据。Objective To explore the predictive value of modified infection probability score(mIPS score)combined with T lymphocyte subsets in malignant hematological diseases chemotherapy agranulocytosis phase complicated with bloodstream infection.Methods Selected 100 adult patients(≥18 years old)who had first-onset malignant hematological diseases and received chemotherapy from April 2018 to November 2020 in the Department of Hematology of the First Affiliated Hospital of Kunming Medical University as the research objects.According to the outcome of bloodstream infection,they were divided into infection group(33 cases)and non-infection group(67 cases).Collected the patient′s general information,pre-chemotherapy,agranulocytosis stage mIPS score and T lymphocyte subsets(CD3^(+),CD4^(+),CD4^(+)/CD8^(+)),and other indicators,analyzed their changes.The receiver operating characteristic curve(ROC curve)was used to evaluate the predictive value of bloodstream infection,and Logistic multivariate regression was used to analyze the independent risk factors of blood stream infection during the agranulocytosis stage of chemtherapy for malignant hematological diseases.Results The mIPS score of the two groups patients during the agranulocytosis phase was significantly increased compared with that before chemotherapy,and the infection group was higher than that of the non-infection group,the differences were statistically significant(P<0.05).During the agranulocytosis phase,CD3^(+),CD4^(+),CD4^(+)/CD8^(+) of the two groups patients were significantly lower than those before chemotherapy,and the infection group was lower than the non-infection group,the differences were statistically significant(P<0.05).The mIPS score combined with T lymphocyte subsets had the best predictive ability for bloodstream infection during the agranulocytosis phase of chemtherapy for malignant hematological diseases,the area under the ROC curve(AUC)was 0.898,the AUC of the mIPS score CD3^(+),CD4^(+),CD4^(+)/CD8^(+) individual indicators were 0.820,0.697,0.6

关 键 词：感染可能性评分 T淋巴细胞亚群 恶性血液病 血流感染 

分 类 号：R552[医药卫生—血液循环系统疾病] R446.1[医药卫生—内科学]