血清GDF-15及临床常用炎症指标在诊断血液恶性肿瘤患者血流感染中的应用价值  

The Value of Serum GDF-15 and Common Clinical Inflammatory Indicators in Patients with Hematological Malignancy Combined with Bloodstream Infection

作　　者：王兵 满其航[2] 徐旭[1] 梁国威[1] WANG Bing;MAN Qihang;XU Xu;LIANG Guowei(Clinical Laboratory Department,Aerospace Center Hospital,Beijing 100049,China;Department of Hematology,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院检验科,北京100049 [2]航天中心医院血液科,北京100049

出　　处：《标记免疫分析与临床》2023年第1期30-36,共7页Labeled Immunoassays and Clinical Medicine

基　　金：航天中心医院第七届青年创新基金项目(编号:2021QN10)。

摘　　要：目的探索血清GDF-15及临床常用炎症指标hs-CRP、PCT、SAA和AGP在诊断血液系统肿瘤患者发生血流感染中的应用价值,为血流感染患者诊断筛选新的标志物。方法纳入2021年3月至2022年10月在航天中心医院血液科收治的疑似血流感染的患者标本,根据血培养结果分为血流感染组(51例)和非血流感染组(81例),检测两组患者血清GDF-15、hs-CRP、PCT、SAA和AGP的水平。采用Mann-Whitney U检验和ROC曲线分析来确定各个指标对于血流感染诊断的灵敏度和特异性,通过约登指数确定诊断界值。结果血流感染组患者的GDF-15、hs-CRP、PCT和SAA水平均显著高于非血流感染组(P值分别为0.018、0.007、<0.001和0.009),但两组间AGP水平差异无统计学意义(P=0.056)。ROC曲线分析发现血清GDF-15、hs-CRP、PCT和SAA用于诊断血液肿瘤患者是否发生血流感染的曲线下面积分别0.623、0.639、0.690和0.635(P<0.05),各指标的AUC差异无统计学意义(P>0.05)。另外,血清GDF-15、hs-CRP、PCT和SAA水平在革兰氏阴性菌组和革兰氏阳性菌组间差异无统计学意义。造血干细胞移植后发生血流感染的患者血清GDF-15水平显著高于移植前的血流感染患者(P=0.010),但是两组间hs-CRP、PCT和SAA水平差异无统计学意义。结论血清GDF-15、hs-CRP、PCT和SAA均可以用于预测血液肿瘤患者是否发生血流感染。血清GDF-15的灵敏度和特异性与目前常用的炎症指标hs-CRP、PCT和SAA相同,这也为临床判断血流感染提供了一种新选择。造血干细胞移植后发生血流感染的患者血清GDF-15水平明显高于移植前发生血流感染的患者,具体的机制有待于进一步的研究。Objective To explore the application value of serum GDF-15 and clinical common inflammatory indicators hs-CRP,PCT,SAA and AGP in patients with hematological malignancy combined with bloodstream infection,and to identify potential new markers for patients with bloodstream infection.Methods Patients with suspected bloodstream infection admitted to the Hematology Department of the Aerospace Center Hospital from March,2021 to October,2022 were included for the current study.According to the results of blood culture,these patients were divided into the bloodstream infection group(51 cases)and non-bloodstream infection group(81 cases).Levels of serum GDF-15,hs-CRP,PCT,SAA and AGP were measured.Mann-Whitney U test and ROC curve analysis were used to determine the sensitivity and specificity of each index for the diagnosis of bloodstream infection,and the diagnostic threshold value was calculated by Youden index.Results Levels of GDF-15,hs-CRP,PCT and SAA in the bloodstream infection group were significantly higher than those in the non-bloodstream infection group(P values were 0.018,0.007,<0.001 and 0.009,respectively).However,there was no significant difference in AGP level between the two groups(P=0.056).ROC curve analysis showed that the area under the ROC curve of serum GDF-15,hs-CRP,PCT and SAA used to diagnose bloodstream infection were 0.623,0.639,0.690 and 0.635,respectively(P<0.05),and there was no significant difference in AUC of each indicator(P>0.05).In addition,there was no difference in the levels of serum GDF-15,hs-CRP,PCT and SAA between the Gram-negative bacteria and the Gram-positive bacteria groups.The level of serum GDF-15 in patients with bloodstream infection after hematopoietic stem cell transplantation was significantly higher than that in patients before transplantation(P=0.010),but there was no significant difference in the levels of hs-CRP,PCT and SAA between the two groups.Conclusion Serum GDF-15,hs-CRP,PCT and SAA can be used to predict whether patients with hematological malignancy combine

关 键 词：GDF-15 炎症指标 血液恶性肿瘤 血流感染 

分 类 号：R733[医药卫生—肿瘤]