PCT和PSPN对急性髓系白血病化疗期间发热性中性粒细胞减少症患者细菌感染的鉴别价值  

The differential value of PCT and PSPN in infectious febrile neutropenia during chemotherapy for acute myeloid leukemia

作　　者：曲伟 商军锋 邹慧琳 杨瑞芳 QU Wei;SHANG Junfeng;ZOU Huilin;YANG Ruifang(Department of Blood Transfusion,Yantai Affiliated Hospital of Binzhou Medical College,Shandong Yantai 264100,China;Department of Laboratory Medicine,Dongying District People's Hospital,Shandong Dongying 257000,China;Department of Hematology,Yantai Affiliated Hospital of Binzhou Medical College,Shandong Yantai 264100,China;Department of Medical Laboratory,Yantai Affiliated Hospital of Binzhou Medical College,Shandong Yantai 264100,China)

机构地区：[1]滨州医学院烟台附属医院输血科,山东烟台264100 [2]东营市东营区人民医院检验科,山东东营257000 [3]滨州医学院烟台附属医院血液内科,山东烟台264100 [4]滨州医学院烟台附属医院医学检验科,山东烟台264100

出　　处：《现代肿瘤医学》2024年第9期1703-1708,共6页Journal of Modern Oncology

基　　金：山东省烟台市科技计划项目(编号:2022YD077)。

摘　　要：目的:探讨降钙素原(procalcitonin,PCT)和可溶性白细胞分化抗原14亚型(soluble cell differentiation antigen 14,sCD14,又称presepsin,PSPN)对急性髓系白血病(acute myeloid leukemia,AML)化疗期间发热性中性粒细胞减少症(febrile neutropenia,FN)患者细菌感染的鉴别价值。方法:纳入2018年07月至2022年02月期间在我院接受化疗且出现FN的121例AML患者,分为非细菌感染组化疗期间发生FN且发热原因不明(细菌培养阴性,无临床迹象表明存在感染)与细菌感染组菌血症(血培养阳性)和局部感染(血培养阴性,细菌培养提示局部感染)。通过酶联免疫吸附试验试剂盒检测FN发病第1至3天血浆PCT和PSPN水平。结果:与非细菌感染组相比,细菌感染组患者FN发病第1至3天的PCT和PSPN水平明显更高,差异有统计学意义(P<0.05)。第1、2、3天的PCT水平鉴别FN细菌感染的曲线下面积(area under the curve,AUC)分别为0.882、0.737、0.715,而PSPN诊断AUC分别为0.799、0.729、0.703。此外,PCT和PSPN联用可进一步提高对FN细菌感染诊断的AUC值(0.892、0.808、0.763)。发病第1天PCT≥2.02 ng/mL或者PSPN≥2.40μg/L,FN细菌感染风险显著增加(P<0.05);校正混杂因素后,当PSPN≥2.91μg/L时,AML患者FN细菌感染风险增加2.177~2.624倍(P<0.05)。Spearman相关性分析显示PCT与细菌性脓毒症患者序贯器官功能衰竭评分(sequential organ failure assessment,SOFA)呈正相关(P<0.001),PSPN值与SOFA评分无显著相关性(P>0.05)。结论:PCT较PSPN在区分FN细菌感染性病因和非感染病因方面准确性更高,其浓度与细菌性脓毒症的严重程度有关;二者联用能进一步提高PCT对FN细菌感染的诊断效能。Objective:To investigate the identified value of procalcitonin(PCT)and presepsin(PSPN)in bacterial infection in patients with febrile neutropenia(FN)during chemotherapy for acute myeloid leukemia(AML).Methods:A total of 121 AML patients with FN who received chemotherapy in our hospital from July 2018 to February 2022 were included into the non-bacterial infection group FN and fever of unknown cause(negative bacterial culture,no clinical signs of infection)during chemotherapy and the bacterial infection group bacteremia(positive blood culture),local infection(negative blood culture,bacterial culture suggests local infection)and clinically confirmed infection.Plasma PCT and PSPN levels were detected by an enzyme-linked immunosorbent assay kit on the 1st to 3rd day of FN onset.Results:Compared with the non-bacterial infection group,the levels of PCT and PSPN in the bacterial infection group were significantly higher on the first to third day of FN onset,with statistical significance(P<0.05).The area under the curve(AUC)for PCT level identification of FN bacterial infection at day 1,2 and 3 were 0.882,0.737 and 0.715,respectively,while the AUC for diagnosis of PSPN were 0.799,0.729 and 0.703,respectively.In addition,the combination of PCT and PSPN could further improve the AUC value of FN bacterial infection diagnosis(0.892,0.808,0.763).The risk of FN bacterial infection was significantly increased in patients with PCT≥2.02 ng/mL or PSPN≥2.40μg/L on the first day of the disease(P<0.05).After adjusting for confounding factors,the risk of FN bacterial infection in AML patients increased by 2.177~2.624 times when PSPN≥2.91μg/L(P<0.05).Spearman correlation analysis showed that PCT was positively correlated with sequential organ failure assessment(SOFA)score of bacterial sepsis patients(P<0.001),but PSPN value was not significantly correlated with SOFA score(P>0.05).Conclusion:Compared with PSPN,PCT was more accurate in distinguishing the causes of FN bacterial infection from non-infectious causes,and its concentr

关 键 词：降钙素原 可溶性白细胞分化抗原14亚型 急性髓系白血病 感染性发热性中性粒细胞减少症 

分 类 号：R733[医药卫生—肿瘤]