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中华临床医师杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 321 -326. doi: 10.3877/cma.j.issn.1674-0785.2021.05.001

临床研究

降钙素原对造血干细胞移植术后患者感染的诊断价值
李珊珊1, 鲍会章1, 贾玫1, 王春燕1,()   
  1. 1. 100044 北京,北京大学人民医院检验科
  • 收稿日期:2021-03-15 出版日期:2021-05-15
  • 通信作者: 王春燕

Clinical significance of serum procalcitonin in patients with infection after hematopoietic stem cell transplantation

Shanshan Li1, Huizhang Bao1, Mei Jia1, Chunyan Wang1,()   

  1. 1. Clinical Laboratory, Peking University People's Hospital, Beijing 100044, China
  • Received:2021-03-15 Published:2021-05-15
  • Corresponding author: Chunyan Wang
引用本文:

李珊珊, 鲍会章, 贾玫, 王春燕. 降钙素原对造血干细胞移植术后患者感染的诊断价值[J/OL]. 中华临床医师杂志(电子版), 2021, 15(05): 321-326.

Shanshan Li, Huizhang Bao, Mei Jia, Chunyan Wang. Clinical significance of serum procalcitonin in patients with infection after hematopoietic stem cell transplantation[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(05): 321-326.

目的

观察降钙素原(PCT)、C反应蛋白(CRP)、D二聚体水平在造血干细胞移植(HSCT)术后感染患者中的应用价值,并联合血培养分析早期感染致病菌类型。

方法

选取2016年10月至2019年10月,北京大学人民医院收治的939例接受HSCT的血液病患者参与研究,其中对照组668例,感染组271例。检测患者PCT、CRP、D二聚体水平,评估PCT和CRP在骨髓移植后感染患者中的应用价值。

结果

感染组PCT水平[2.06(0.57,5.72)ng/ml]明显高于对照组[0.19(0.12,0.30)ng/ml](P<0.001);CRP水平[69.56(23.68,121.67)mg/L]明显高于对照组[41.02(13.43,93.96)mg/L](P<0.001);D二聚体水平[441(246,873)mg/ml]显著高于对照组[335(183,713.5)mg/ml](P<0.001)。鉴别HSCT后患者是否感染,PCT的ROC曲线下面积为0.877,有临床诊断价值(P<0.05),最佳截断值为0.51 ng/ml;CRP的ROC曲线下面积为0.591,有临床诊断价值(P<0.05),最佳截断值为49.2 mg/L。血培养结果显示,革兰阳性菌感染94例,革兰阴性菌感染158例,真菌感染19例。PCT水平在革兰阴性菌感染患者中最高[4.57(1.46,10.77)ng/ml],与革兰阳性菌感染患者[0.65(0.29,1.32)ng/ml]和真菌感染患者[2.10(1.57,2.88)ng/ml]比较,差异有统计学意义(P<0.001)。当PCT水平为1.63 ng/ml是鉴别革兰阴性菌及革兰阳性菌感染的最佳截断值。

结论

血清PCT能很好区分HSCT术后患者是否感染及感染菌群类型,对患者感染的诊断及治疗有指导意义。

Objective

To assess the application value of serum procalcitonin (PCT), C-reactive protein (CRP), and D-dimer levels in patients with infection after hematopoietic stem cell transplantation (HSCT), and to analyze the types of pathogenic bacteria for early infection by blood culture.

Methods

From October 2016 to October 2019, 939 patients with HSCT admitted to Peking University People's Hospital were enrolled in this study, including 668 patients without infection (control group) and 271 with infection (infection group). Serum levels of PCT, CRP, and D-dimer were detected to evaluate the application value of serum PCT and CRP in patients with infection after bone marrow transplantation.

Results

Serum levels of PCT [2.06 (0.57, 5.72) ng/ml], CRP [69.56 (23.68, 121.67) mg/L], and D-dimer [441 (246,873) mg/ml] in the infection group were significantly higher than those in the control group [0.19 (0.12, 0.30) ng/mL, 41.02 (13.43, 93.96) mg/L, and 335 (183,713.5) mg/ml, respectively; P<0.001]. The area under the ROC curve of PCT and CRP was 0.877 and 0.591, and the best cut-off value was 0.51 ng/m and 49.2 mg/L, respectively, suggesting that both had clinical diagnostic value (P<0.05). The results of blood culture showed that there were 94 cases of Gram-positive bacterial infection, 158 cases of Gram-negative bacterial infection, and 19 cases of fungal infection. PCT level was the highest in Gram-negative bacteriaemia patients [4.57 (1.46, 10.77) ng/ml], which was significantly higher than those in Gram-positive bacteriaemia patients [0.65 (0.29, 1.32) ng/ml] and fungal infection patients [2.10 (1.57, 2.88) ng/ml] (P<0.001). And 1.63 ng/ml is the best cutoff value of PCT to distinguish Gram-negative and Gram-positive bacterial infection.

Conclusion

Serum PCT can help identify whether patients are infected and the type of infected bacteria after HSCT, which has guiding significance for clinicians in diagnosis and treatment.

表1 造血干细胞移植后感染组与对照组患者PCT、CRP、D二聚体水平比较
表2 造血干细胞移植后不同感染类型患者PCT、CRP、D二聚体水平比较
图1 PCT和CRP鉴别造血干细胞移植后患者是否感染的ROC曲线。PCT 截断值为0.51 ng/ml,CRP 截断值为49.20 mg/L
表3 PCT和CRP鉴别造血干细胞移植后患者是否感染的各临界值特征
图2 PCT鉴别造血干细胞移植后患者革兰阳性菌和革兰阴性菌感染的ROC曲线。PCT 截断值为1.63 ng/ml
表4 PCT鉴别造血干细胞移植后患者革兰阴性菌及革兰阳性菌感染的各临界值特征
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