流式微球阵列技术鉴别诊断多发性骨髓瘤患者感染状态及类型的价值  

Value of cytometry microsphere array technology in differential diagnosis of infection status and types in patients with multiple myeloma

作　　者：胡姗姗 黄黎[1] 罗信国[1] 朱艳[1] HU Shanshan;HUANG Li;LUO Xinguo;ZHU Yan(Department of Hematology,Jinhua People's Hospital,Jinhua,321000,China)

机构地区：[1]金华市人民医院血液内科,浙江金华321000

出　　处：《临床血液学杂志》2024年第2期117-122,共6页Journal of Clinical Hematology

基　　金：浙江省金华市科学技术局公益类项目(No:2021-4-075)。

摘　　要：目的:探析流式微球阵列技术(cytometric bead array,CBA)鉴别诊断多发性骨髓瘤(multiple myeloma,MM)患者感染状态及类型的价值。方法:采用回顾性队列研究方法,收集2019年1月—2022年12月医院收治的214例MM患者临床资料,按照是否感染分为MM合并感染患者作为观察组(110例),MM未感染患者作为对照组(104例)。110例感染观察组中,49例为革兰阳性菌感染(G^(+)菌感染组),48例为革兰阴性菌感染(G^(-)菌感染组),13例为真菌感染。所有样本采用CBA检测技术检测Th1/Th2细胞因子谱。比较辅助性T细胞(Th)1/Th2细胞因子谱、C-反应蛋白(CRP)和降钙素原(PCT)水平,观察MM患者未感染及感染状态下Th1/Th2细胞因子谱特征,分析CBA检测技术检测Th1/Th2细胞因子谱评估MM患者感染的价值。结果:观察组肿瘤坏死因子-α(TNF-α)、干扰素(IFN)-γ、白细胞介素(IL)-6、IL-10、CRP和PCT水平均高于对照组,差异有统计学意义(P<0.05);2组IL-2、IL-4水平比较,差异无统计学意义(P>0.05)。G^(-)菌感染组IL-6、IL-10、CRP和PCT水平高于G^(+)菌感染组和真菌感染组,且G^(+)菌感染组IL-6、CRP水平高于真菌感染组,PCT水平低于真菌感染组,差异有统计学意义(P<0.05);感染的3组中IL-2、TNF-α、IFN-γ和IL-4水平比较,差异无统计学意义(P>0.05)。绘制受试者工作特征曲线(ROC)显示,TNF-α、IFN-γ、IL-6、IL-10、CRP和PCT对MM患者感染情况的评估价值均良好,且以IL-6和IL-10的评估价值最为显著;IL-6、IL-10、CRP和PCT评估不同感染类型的MM合并感染患者的价值均良好。结论:相比于传统CRP、PCT等传统指标,CBA技术检测Th1/Th2细胞因子谱对于MM患者早期感染的快速诊断、严重程度评估有重要价值,以TNF-α、IFN-γ、IL-6、IL-10水平均明显升高为特征,且有助于进一步辅助鉴别G^(+)菌和G^(-)菌感染类型。Objective: To explore the value of cytometric bead array(CBA)in differential diagnosis of infection status and types in patients with multiple myeloma(MM).Methods: A retrospective cohort study was used to collect the clinical data of 214 patients with MM admitted to the hospital from January 2019 to December 2022.According to whether had infection these patients was divided into MM patients with infection as the observation group(110 cases),MM patients without infection as the control group(104 cases),of which 110 cases of infection in the observation group,49 cases of Gram-positive bacteria infection(G^(+)bacteria infection group),48 cases of Gram-negative bacteria infection(G^(-)bacteria infection group),13 cases of fungal infection.All samples were tested for Th1/Th2 cytokine profiles using CBA detection technology.The characteristics of Th1/Th2 cytokine profile in uninfected and infected MM patients were observed,and the value of CBA detection of Th1/Th2 cytokine profile in evaluating infection in MM patients was analyzed.Results: The levels of tumor necrosis factor-α(TNF-α),interferon(IFN)-γ,interleukin(IL)-6,IL-10,CRP and PCT in the observation group were higher than those in the control group,with a statistical significant difference(P<0.05).There was no statistical significant difference in the levels of IL-2 and IL-4 between the two groups(P>0.05).The levels of IL-6,IL-10,CRP and PCT in G^(-)bacterial infection group were higher than those in G^(+)bacterial infection group and fungal infection group,and the levels of IL-6 and CRP in G^(+)bacterial infection group were higher than those in fungal infection group,and the level of PCT was lower than that in fungal infection group,with a statistical significant difference(P<0.05).There was no statistical significant difference in the levels of IL-2,TNF-α,IFN-γ,and IL-4 among the three groups(P>0.05).The receiver operating characteristic curve(ROC)was drawn and the results showed that TNF-α,IFN-γ,IL-6,IL-10,CRP,and PCT had good evaluation value for inf

关 键 词：多发性骨髓瘤 感染 流式微球阵列技术 Th1/Th2细胞因子谱 C-反应蛋白 降钙素原 

分 类 号：R733.3[医药卫生—肿瘤]