首次出现发热性中性粒细胞减少症的成人AML患者CK-18的诊断价值  

Diagnostic value of CK-18 in adult AML patients with febrile neutropenia for the first time

作　　者：赵叶飞 高峰[1] 吴晓[1] 陈莉[2] ZHAO Yefei;GAO Feng;WU Xiao;CHEN Li(Department of Hematology,Zhangjiagang First People′s Hospital,Zhangjiagang 215600,China)

机构地区：[1]张家港市第一人民医院血液科,江苏张家港215600 [2]张家港市第一人民医院全科医学科,215600

出　　处：《临床肿瘤学杂志》2024年第3期234-239,共6页Chinese Clinical Oncology

摘　　要：目的探讨首次出现发热性中性粒细胞减少症(FN)的成人急性髓系白血病(AML)患者血浆半胱氨酸-天冬氨酸蛋白水解酶-3裂解的细胞角蛋白-18(CK-18)片段的诊断价值。方法收集2017年11月至2021年12月在张家港市第一人民医院血液科接受血液肿瘤强化化疗的75例AML-FN患者。在FN发作时(d_(0))、第1天(d_(1))和第2天(d_(2))测量血浆CK-18片段M30、C反应蛋白(CRP)和降钙素原(PCT)水平。对化疗期间血流感染(BSI)和脓毒症的发生情况进行评估。结果8例患者出现脓毒症,25例患者有血液培养阳性感染[BSI(+)]。BSI(+)组患者血浆CK-18水平在发热后d_(1)达到峰值。d_(1)和d_(2)时较高的血浆CK-18水平与BSI(+)和脓毒症有关。受试者工作特征(ROC)曲线分析中,d_(1) CK-18预测BSI(+)的曲线下面积(AUC)最高,为0.832(95%CI:0.742~0.922),稍高于PCT和CRP(P<0.05)。d_(1) CK-18预测脓毒症的AUC值也较高,略高于PCT和CRP,差异无统计学意义(P>0.05)。d_(0)~d_(2)期间CK-18峰值与PCT峰值有关,BSI(+)患者的相关系数(0.407)高于BSI(-)患者(0.182)。结论在AML患者中,血浆CK-18片段被发现是FN早期BSI(+)和脓毒症的潜在诊断标志物。Objective To investigate the diagnostic value of cytokeratin-18(CK-18)fragments cleaved from plasma cysteine-aspartate proteolytic enzymase-3 in adult acute myeloid leukemia(AML)patients with febrile neutropenia(FN)for the first time.Methods Seventy-five AML-FN patients who received intensive chemotherapy for hematologic tumors in the hematology ward of the Zhangjiagang First People′s Hospital from November 2017 to December 2021 were collected.Plasma CK-18 fragment M30,C-reactive protein(CRP),and procalcitonin(PCT)levels were measured at FN onset(d_(0)),day 1(d_(1)),and day 2(d_(2)).The occurrence of bloodstream infections(BSI)and sepsis during chemotherapy was evaluated.Results Eight patients had sepsis and_(2)5 patients had blood culture positive infection(BSI+).Plasma CK-18 levels in BSI(+)group peaked on d1 after fever.Higher plasma CK-18 levels at d1 and d2 are associated with BSI(+)and sepsis.In ROC curve analysis,the area under the curve(AUC)of d1 CK-18 predicted BSI(+)was the highest 0.832(95%CI:0.742-0.922),slightly higher than PCT and CRP(P<0.05).The AUC value of d1 CK-18 was also higher in predicting sepsis,slightly higher than PCT and CRP,and the difference was not statistically significant(P>0.05).The peak value of CK-18 was correlated with the peak value of PCT during d_(0)~d_(2),and the correlation coefficient of BSI(+)patients(0.407)was higher than that of BSI(-)patients(0.182).Conclusion In patients with AML,plasma CK-18 fragment has been found to be a potential diagnostic marker for early BSI(+)and sepsis of FN.

关 键 词：急性髓系白血病 发热性中性粒细胞减少症 细胞角蛋白-18片段 降钙素原 血流感染 脓毒症 

分 类 号：R733[医药卫生—肿瘤]