血清hs-CRP、PCT、LDH水平变化与急性白血病合并细菌感染患者预后的关联性分析

肖霄; 张城

doi:10.13201/j.issn.1004-2806.2021.04.004

血清hs-CRP、PCT、LDH水平变化与急性白血病合并细菌感染患者预后的关联性分析

肖霄,
张城^,

- 复旦大学附属金山医院检验科(上海,201508)

详细信息

通讯作者: 张城,E-mail:1663975286@qq.com

中图分类号: R733

收稿日期: 2020-10-23

Changes of serum hs-CRP, PCT and LDH levels and their correlation with prognosis of patients with acute leukemia and bacterial infection

XIAO Xiao,
ZHANG Cheng^,

- Department of Clinical Laboratory, Jinshan Hospital of Fudan University, Shanghai, 201508, China

More Information

Corresponding author: ZHANG Cheng, E-mail: 1663975286@qq.com

Received Date: 23 October 2020

摘要

摘要: 目的:探索血清高敏C反应蛋白(hs-CRP)、降钙素原(PCT)、乳酸脱氢酶(LDH)水平变化与急性白血病合并细菌感染患者预后的关联性分析。方法:选取2019年1月—2019年12月就诊的急性白血病合并细菌感染患者86例作为感染组,同期单纯白血病且未出现感染患者40例作为对照组。检测血清hs-CRP、PCT、LDH水平,比较2组血清hs-CRP、PCT、LDH水平;感染组治疗前后hs-CRP、PCT、LDH水平;比较不同预后情况hs-CRP、PCT、LDH水平;利用受试者工作特征曲线(ROC)评估血清hs-CRP、PCT、LDH对急性白血病合并细菌感染患者预后的预测价值。结果:感染组血清hs-CRP、PCT、LDH水平显著高于对照组(P<0.05);治疗后感染组血清hs-CRP、PCT、LDH水平与治疗前比较显著降低(P<0.05);持续感染组、感染性休克组、感染性死亡组血清hs-CRP、PCT、LDH水平显著高于恢复组,且感染性死亡组血清hs-CRP、PCT、LDH水平高于持续性感染组(P<0.05);绘制ROC曲线,血清hs-CRP诊断急性白血病合并细菌感染患者预后的AUC为0.762,PCT的AUC为0.718,LDH的AUC为0.706,三者联合诊断的AUC为0.862,高于三者单独诊断的AUC值。结论:血清hs-CRP、PCT、LDH水平联合诊断急性白血病合并细菌感染患者预后效能较高,可作为指导临床治疗指标。
- 白血病感染 /
- C反应蛋白 /
- 降钙素原 /
- 乳酸脱氢酶 /
- 预后
Abstract: Objective: To explore the changes in levels of serum high-sensitivity C-reactive protein(hs-CRP), procalcitonin(PCT) and lactate dehydrogenase(LDH) and their correlation with prognosis of patients with acute leukemia and bacterial infection.Methods: During the period from January to December 2019, 86 patients with acute leukemia and bacterial infection were enrolled as infection group, while another 40 patients only with leukemia were enrolled as control group. The levels of serum hs-CRP, PCT and LDH were measured. The levels of serum hs-CRP, PCT and LDH between the two groups, in infection group before and after treatment, as well as among patients with different prognosis were compared. The predictive value of serum hs-CRP, PCT and LDH for prognosis was evaluated by receiver operating characteristic(ROC) curves.Results: The levels of serum hs-CRP, PCT and LDH in infection group were significantly higher than those in control group(P<0.05). After treatment, levels of serum hs-CRP, PCT and LDH in infection group were significantly decreased(P<0.05). The levels of serum hs-CRP, PCT and LDH in persistent infection group, infectious shock group and infectious death group were significantly higher than those in recovery group, which were higher in infectious death group than persistent infection group(P<0.05). ROC curves were drew. AUC values of serum hs-CRP, PCT and LDH for diagnosis of prognosis in patients with acute leukemia and bacterial infection were 0.762, 0.718 and 0.706, respectively. AUC of their combined diagnosis was 0.862, higher than that of single index.Conclusion: The diagnostic efficiency of serum hs-CRP combined with PCT and LDH was higher for the diagnosis of prognosis in the patients with acute leukemia and bacterial infection, which could be applied as indexes to guide clinical treatment.
- leukemia infection /
- hs-CRP /
- PCT /
- LDH /
- prognosis

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参考文献(21)

[1]	Vetrie D,Helgason GV,Copland M.The leukaemia stem cell:similarities,differences and clinical prospects in CML and AML[J].Nat Rev Cancer,2020,20(3):158-173.
[2]	于佳宁,周芙玲.急性白血病的免疫治疗研究进展[J].医学综述,2020,26(11):2194-2198,2203.
[3]	Pelland-Marcotte MC,Pole JD,Hwee J,et al.LongTerm Risk of Infections After Treatment of Childhood Leukemia:A Population-Based Cohort Study U-sing Administrative Health Data[J].J Clin Oncol,2019,37(29):2651-2660.
[4]	吴玉红,邵宗鸿.再生障碍性贫血感染的研究进展[J].天津医药,2018,46(12):1342-1346.
[5]	陈超华.白血病合并细菌感染患者检测外周血nCD4的应用价值[J].临床血液学杂志,2018,31(10):765-767.
[6]	Lin B,Kennedy B,McBride J,et al.Long-term morbidity of respiratory viral infections during chemotherapy in children with leukaemia[J].Pediatr Pulmonol,2019,54(11):1821-1829.
[7]	Klein K,Hasle H,Abrahamsson J,et al.Differences in infection prophylaxis measures between paediatric acute myeloid leukaemia study groups within the international Berlin-Frankfürt-Münster (I-BFM)study group[J].Br J Haematol,2018,183(1):87-95.
[8]	刘红萍,邓裕灵,马海霞.循证护理对急性白血病化疗患者感染预防与生存质量的影响[J].护理实践与研究,2019,16(9):29-31.
[9]	王平平,罗玉敏,高利,等.C-反应蛋白及其基因多态性与缺血性脑卒中的研究进展[J].中国中西医结合急救杂志,2020,27(3):382-384.
[10]	姜柳米,王进平,张敏,等.急性缺血性脑卒中患者血清NSE、hs-CRP水平与脑梗死体积、NIHSS评分的关系及临床指导意义[J].临床急诊杂志,2019,20(2):132-135.
[11]	Herishanu Y,Polliack A,Shenhar-Tsarfaty S,et al.Increased serum C-reactive protein levels are associated with shorter survival and development of second cancers in chronic lymphocytic leukemia[J].Ann Med,2017,49(1):75-82.
[12]	洪梅,张宗娟.C反应蛋白血清乳酸脱氢酶β2微球蛋白检测对急性白血病患者治疗及预后评估的意义[J].山西医药杂志,2017,46(24):3057-3059.
[13]	李妍,国虹,孙成栋.白血病感染患者血清hs-CRP、PCT水平与血小板参数的变化及其相关性研究[J].临床和实验医学杂志,2020,19(8):882-885.
[14]	Rodríguez A,Reyes LF,Monclou J,et al.Relationship between acute kidney injury and serum procalcitonin(PCT)concentration in critically ill patients with influenza infection[J].Med Intensiva,2018,42(7):399-408.
[15]	Shilpakar R,Paudel BD,Neupane P,et al.Procalcitonin and C-Reactive Protein As Markers of Bacteremia in Patients With Febrile Neutropenia Who Receive Chemotherapy for Acute Leukemia:A Prospective Study From Nepal[J].J Glob Oncol,2019,5:1-6.
[16]	韩少玲,吴亚兵,张家友.外周血CD64及血清PCT、hs-CRP水平在急性白血病化疗后合并细菌感染中的应用[J].标记免疫分析与临床,2020,27(7):1151-1156.
[17]	Ding J,Karp JE,Emadi A.Elevated lactate dehydrogenase(LDH)can be a marker of immune suppression in cancer:Interplay between hematologic and solid neoplastic clones and their microenvironments[J].Cancer Biomark,2017,19(4):353-363.
[18]	苌哲宗,余红岚,费樱,等.儿童急性淋巴细胞白血病患者外周血IL-7、TK1、LDH水平变化的临床意义及其相关性研究[J].贵州医药,2018,42(4):401-403.
[19]	苏学成,王宁玲,刘亢亢.血清乳酸脱氢酶水平与急性淋巴细胞白血病患儿危险度关系的研究[J].安徽医药,2018,22(3):474-477.
[20]	刘元军,青胜兰,徐锋,等.血清LDH、可溶性CD44、SF在骨髓增生异常综合征和急性髓系白血病诊断中的临床意义[J].标记免疫分析与临床,2018,25(8):1137-1141.
[21]	李妮.网织血小板、C-反应蛋白、降钙素原检测在急性白血病继发感染中的诊断价值[J].中国医药导报,2019,16(3):179-180,封3.