细胞因子谱在急性白血病患儿感染诊断中的价值  

Value of Cytokines in Diagnosis of Infection in Children with Acute Leukemia Complicated with Infection

作　　者：李秋菊 徐学聚[1] 张园[1] 闵燕萍 LI Qiuju;XU Xueju;ZHANG Yuan;MIN Yanping(Department of Pediatric Hematology Oncology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院儿童血液肿瘤科,河南郑州450052

出　　处：《河南医学研究》2022年第18期3290-3293,共4页Henan Medical Research

摘　　要：目的探讨细胞因子谱在急性淋巴细胞白血病(ALL)及急性髓系白血病(AML)合并感染时的差异及与感染程度的相关性,指导急性白血病(AL)合并感染患儿的治疗。方法回顾性分析郑州大学第一附属医院2019年7月至2021年5月收治的54例AL合并感染患儿的临床病例资料,根据基础疾病分为ALL组和AML组。根据感染程度分为重度感染组和轻度感染组。另收集同期就诊于郑州大学第一附属医院的健康体检儿童30例为对照组。病例组在患儿出现发热时测定降钙素原(PCT)及血清细胞因子水平,比较细胞因子谱在各组的差异及与感染严重程度的相关性。结果54例AL患儿中,36例为ALL,18例为AML;重度感染者30例,轻度感染者24例。ALL组、AML组与对照组PCT、白细胞介素(IL)-4、IL-6、IL-10、IL-17、肿瘤坏死因子α(TNF-α)、干扰素γ(INF-γ)差异有统计学意义(P<0.05)。ALL及AML组PCT、IL-4、IL-6、IL-10、IL-17、TNF-α、INF-γ水平均高于对照组(P<0.05);ALL组IL-6、IL-10水平高于AML组(P<0.05),两组PCT、IL-4、IL-17、TNF-α、INF-γ比较,差异无统计学意义(P>0.05)。ALL患儿中重度感染组PCT、IL-6、IL-10水平高于轻度感染组(P<0.05),两组IL-4、IL-17、TNF-α、INF-γ比较,差异无统计学意义(P>0.05);PCT、IL-6、IL-10曲线下面积(AUC)分别为0.723、0.898、0.864(P<0.05)。AML患儿中重度感染组PCT、IL-10水平高于轻度感染组(P<0.05),两组IL-4、IL-6、IL-17、TNF-α、INF-γ比较,差异无统计学意义(P>0.05);PCT、IL-10的AUC分别为0.846、0.815(P<0.05)。结论ALL患儿合并感染时细胞因子水平高于AML患儿;IL-6、IL-10可作为ALL患儿合并重度感染的有效预测指标,IL-6诊断重度感染的能力优于PCT;IL-10诊断AML合并重度感染的能力与PCT相当。Objective To explore the difference of cytokines in acute lymphoblastic leukemia(ALL)and acute myeloid leukemia(AML)and the value of cytokines in diagnosing the severity of infection in children with acute leukemia(AL),in order to provide reference for guiding anti-infection treatment.Methods A total of 54 children with AL admitted to the First Affiliated Hospital of Zhengzhou University from July 2019 to May 2021 were collected retrospectively in this study.They were divided into ALL group and AML group according to their underlying diseases,and they were also divided into severe infection group and mild infection group.In addition,30 healthy children who admitted to the First Affiliated Hospital of Zhengzhou University during the same period were collected as the control group.The levels of procalcitonin(PCT)cytokines were measured in case group when fever occurred.The levels of cytokines were measured for detecting the potential relationship between basic diseases and cytokines and infection severity.Results Among 54 children with AL,36 were ALL and 18 were AML.There were 30 severe cases and 24 mild cases.PCT,interleukin(IL)-4,IL-6,IL-10,IL-17,tumor necrosis factorα(TNF-α)and interferonγ(INF-γ)were different among ALL group,AML group and control group(P<0.05),and the levels of PCT and cytokines in ALL and AML groups were higher than those in control group(P<0.05).The median IL-6 and IL-10 in ALL group were significantly higher than those in AML group(P<0.05).The levels of PCT,IL-6 and IL-10 in ALL and severe infection group were higher than those in ALL and mild infection group(P<0.05).AUC of PCT,IL-6 and IL-10 were 0.723,0.898,0.864,respectively(P<0.05).The levels of PCT and IL-10 in AML and severe infection group were higher than those in AML and mild infection group(P<0.05).AUC of PCT and IL-10 were 0.846 and 0.815,respectively(P<0.05).Conclusion The levels of cytokines in children with ALL were higher than those in children with AML.IL-6 and IL-10 can be effective predictors of severe infection in chil

关 键 词：急性白血病 细胞因子 感染 

分 类 号：R725.5[医药卫生—儿科]