血清降钙素原和C反应蛋白联合检测在恶性血液病发热中的诊断价值
혈청강개소원화C반응단백연합검측재악성혈액병발열중적진단개치
Serum procalcitonin and C-reactive protein detection in diagnosis of fever in hematological maliganancies
  • 万方数据
    中国医师进修杂志 중국의사진수잡지
    CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
    2015年 4期 249-252 ,共4页

    高然%颜晓菁%于锦香%高峰%蔡大利%王柏勋%潘登%张蕊%王晓雪

    고연%안효정%우금향%고봉%채대리%왕백훈%반등%장예%왕효설

    血液肿瘤%发热%C反应蛋白质%降钙素原 血液腫瘤%髮熱%C反應蛋白質%降鈣素原
    혈액종류%발열%C반응단백질%강개소원
    Hematologic neoplasms%Fever%C-reactive protein%Procalcitonin
    目的 探讨血清降钙素原(PCT)和C反应蛋白(CRP)在恶性血液病发热中的诊断价值.方法 回顾性分析186例恶性血液病伴发热患者以及30例恶性血液病无发热患者血清PCT及CRP水平.根据入选患者临床特征将其分为感染性发热(165例,其中细菌感染102例、真菌感染27例、病毒感染36例)、非感染性发热(21例)和无发热(30例),细菌性感染根据血培养结果分为血培养阳性(24例,其中革兰阴性菌感染12例、革兰阳性菌感染12例)与血培养阴性(78例),比较各类患者血清PCT和CRP水平.结果 感染性发热患者PCT、CRP明显高于非感染性发热患者和无发热患者[1.40 (0.02～54.81) μg/L比0.45 (0.04～12.80) μg/L和0.30 (0.01 ～0.98) μg/L、78.9(3.6 ～ 199.6) mg/L比17.1(2.4～78.9) mg/L和6.7(1.0 ～ 24.2)mg/L],差异有统计学意义(P＜0.05);非感染性发热与无发热患者CRP比较差异有统计学意义(P＜0.05),而PCT比较差异无统计学意义(P＞0.05).细菌感染患者PCT明显高于真菌感染患者和病毒感染患者[1.60(0.28 ～54.81) μg/L比0.55(0.17～9.60) μg/L和0.38(0.02～12.45)μg/L],差异有统计学意义(P＜0.05);真菌感染患者与病毒感染患者PCT比较差异无统计学意义(P＞0.05).细菌感染、真菌感染和病毒感染患者CRP比较差异无统计学意义(P＞0.05).血培养阳性患者PCT和PCT阳性率明显高于血培养阴性患者[2.10(0.35 ～54.81) μg/L比0.78(0.28 ～22.41) μg/L、87.5％ (21/24)比66.7％ (52/78)],差异有统计学意义(P＜0.05).革兰阴性菌感染患者PCT明显高于革兰阳性菌感染患者[6.64(0.56～54.81) μg/L比2.40(0.35 ～34.81)μg/L],差异有统计学意义(P＜0.05);两者PCT阳性率比较差异无统计学意义(P＞0.05).血培养阳性患者与血培养阴性患者、革兰阴性菌感染患者与革兰阳性菌感染患者CRP和CRP阳性率比较差异无统计学意义(P＞0.05).结论 血清PCT水平对于恶性血液病患者感染性发热和非感染性发热有很好的鉴别价值,预测细菌感染快速可靠,尤其对于革兰阴性菌感染特异性高.血清CRP水平对于恶性血液病患者感染性发热与非感染性发热有鉴别意义.
    목적 탐토혈청강개소원(PCT)화C반응단백(CRP)재악성혈액병발열중적진단개치.방법 회고성분석186례악성혈액병반발열환자이급30례악성혈액병무발열환자혈청PCT급CRP수평.근거입선환자림상특정장기분위감염성발열(165례,기중세균감염102례、진균감염27례、병독감염36례)、비감염성발열(21례)화무발열(30례),세균성감염근거혈배양결과분위혈배양양성(24례,기중혁란음성균감염12례、혁란양성균감염12례)여혈배양음성(78례),비교각류환자혈청PCT화CRP수평.결과 감염성발열환자PCT、CRP명현고우비감염성발열환자화무발열환자[1.40 (0.02～54.81) μg/L비0.45 (0.04～12.80) μg/L화0.30 (0.01 ～0.98) μg/L、78.9(3.6 ～ 199.6) mg/L비17.1(2.4～78.9) mg/L화6.7(1.0 ～ 24.2)mg/L],차이유통계학의의(P＜0.05);비감염성발열여무발열환자CRP비교차이유통계학의의(P＜0.05),이PCT비교차이무통계학의의(P＞0.05).세균감염환자PCT명현고우진균감염환자화병독감염환자[1.60(0.28 ～54.81) μg/L비0.55(0.17～9.60) μg/L화0.38(0.02～12.45)μg/L],차이유통계학의의(P＜0.05);진균감염환자여병독감염환자PCT비교차이무통계학의의(P＞0.05).세균감염、진균감염화병독감염환자CRP비교차이무통계학의의(P＞0.05).혈배양양성환자PCT화PCT양성솔명현고우혈배양음성환자[2.10(0.35 ～54.81) μg/L비0.78(0.28 ～22.41) μg/L、87.5％ (21/24)비66.7％ (52/78)],차이유통계학의의(P＜0.05).혁란음성균감염환자PCT명현고우혁란양성균감염환자[6.64(0.56～54.81) μg/L비2.40(0.35 ～34.81)μg/L],차이유통계학의의(P＜0.05);량자PCT양성솔비교차이무통계학의의(P＞0.05).혈배양양성환자여혈배양음성환자、혁란음성균감염환자여혁란양성균감염환자CRP화CRP양성솔비교차이무통계학의의(P＞0.05).결론 혈청PCT수평대우악성혈액병환자감염성발열화비감염성발열유흔호적감별개치,예측세균감염쾌속가고,우기대우혁란음성균감염특이성고.혈청CRP수평대우악성혈액병환자감염성발열여비감염성발열유감별의의.
    Objective To explore the diagnosis significance of serum procalcitonin (PCT) and C-reactive protein(CRP) in the fever of hematological maliganancies.Methods The levels of serum PCT and CRP in 186 fever patients with hematological maliganancies and 30 non-fever patients with hematological maliganancies were analyzed retrospectively.According to the clinical characteristics,the patients were divided into infectious fever patients (165 cases),non-infectious fever patients (21 cases) and non-fever patients (30 cases).The infectious fever patients were divided into the bacterial infection (102 cases),the fungal infection (27 cases),and the virus infection (36 cases).The patients confirmed with bacteria infection were divided into blood culture positive patients (24 cases,including 12 cases of gram-negative bacteria infection and 12 cases of gram-positive bacteria infection) and blood culture negative patients (78 cases) according to the result of blood culture.The levels of serum PCT and CRP were compared.Results The levels of serum PCT and CRP in infectious fever patients were higher than those in non-infectious fever patients and non-fever patients:1.40(0.02-54.81) μ g/L vs.0.45(0.04-12.80) μ g/L and 0.30(0.01-0.98)μ g/L,78.9(3.6-199.6) mg/L vs.17.1(2.4-78.9) mg/L and 6.7(1.0-24.2) mg/L,and there were significant differences (P ＜ 0.05).The difference of the level of serum CRP between non-infectious fever patients and non-fever patients was significantu (P ＜ 0.05),but the difference of the level of serum PCT between noninfectious fever patients and non-fever patients was no significant (P ＞ 0.05).The level of serum PCT in bacterial infection was higher than that in fungal infection and virus infection:1.60 (0.28-54.81) μ g/L vs.0.55 (0.17-9.60) μg/L and 0.38 (0.02-12.45) μ g/L,and there was significant difference (P＜ 0.05).Tbe dfference of the level of serum PCT between fungal infection and virus infection was no significant (P ＞ 0.05).There was no significant difference in the level of serum CRP among bacterial infection,fungal infection and virus infection (P ＞ 0.05).The level of serum PCT and the positive rate of PCT in blood culture positive patients were higher than those in blood culture negative patients:2.10 (0.35-54.81) μ g/L vs.0.78(0.28-22.41) μg/L,87.5％(21/24) vs.66.7％(52/78),there were significant differences (P ＜0.05).The level of serum PCT in gram-negative bacteria infection was higher than that in gram-positive bacteria infection:6.64 (0.56-54.81) μ g/L vs.2.40 (0.35-34.81) μ g/L,and there was significant difference (P ＜ 0.05).But there was no significant difference in the positive rate of PCT(P ＞ 0.05).There were no significant differences in the level of serum CRP and the positive rate of CRP between blood culture positive patients and blood culture negative patients,or between gram-negative bacteria infection and gram-positive bacteria infection (P ＞ 0.05).Conclusions Serum PCT concentration can help to distinguish the infectious fever and noninfectious fever,especially to gram-negative bacteria infection.Serum CRP concentration is significant in distinguishing the infectious fever and non-infectious fever.
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