摘要
目的 探讨白血病化疗后粒细胞缺乏伴感染患者外周血多型核白细胞簇分化抗原64(CD64)指数、可溶性尿激酶型纤溶酶原激活物受体(su-PAR)、白细胞介素-6(IL-6)的变化及其意义.方法 采取回顾性研究方法,选取2022年8月至2023年8月在白银市第一人民医院血液科实施化疗后发生粒细胞缺乏伴感染的白血病患者50例作为感染组,另外选取59例白血病化疗后粒细胞缺乏但未出现感染的患者作为对照组.对比两组患者化疗前(T0)、化疗后粒缺期(T1)、感染组感染时(T2)的CD64指数、su-PAR水平和IL-6水平;采用受试者操作特征(ROC)曲线模型分析CD64、su-PAR、IL-6诊断白血病化疗后粒细胞缺乏伴感染的价值;并观察感染组不同血培养结果及治疗前后患者的CD64指数、su-PAR水平和IL-6水平变化.结果 两组患者T1、T2时的CD64指数、su-PAR水平、IL-6水平均高于T0时,差异均有统计学意义(P＜0.05);感染组患者T1、T2时的CD64指数分别为36.18±5.50、46.28±7.84,su-PAR 水平分别为(23.39±4.11)、(29.30±5.13)ng/mL,IL-6 水平分别为(37.15±7.63)、(43.49±8.63)ng/L,均明显高于对照组[CD64 指数:30.33±4.70、28.61±4.00;su-PAR:(19.63±3.85)、(18.26±3.55)ng/mL;IL-6:(29.82±5.86)、(27.30±6.61)ng/L],差异均有统计学意义(P＜0.05).CD64、su-PAR、IL-6 及三项指标联合应用诊断白血病化疗后粒细胞缺乏伴感染的ROC曲线下面积值分别为0.794、0.734、0.629、0.914.感染组中,有21例患者血培养细菌感染为阳性、有29例患者血培养细菌感染为阴性.阳性患者的CD64指数、su-PAR水平、IL-6水平均显著高于阴性,差异均有统计学意义(P＜0.05).对白血病化疗后粒细胞缺乏伴感染患者给予抗感染治疗,在治疗第3天、第7天时,患者的CD64指数、su-PAR水平、IL-6水平均较治疗第1天显著降低,差异均有统计学意义(P＜0.05).结论 白血病化疗后粒细胞缺乏伴感染患者外周血CD64指数、su-PAR水平、IL-6水平均会显著升高,并且与患者血培养菌阳性、化疗后粒细胞缺乏伴感染发生有明显关系,早期联合检测上述三项指标有较好的诊断灵敏度和特异度.
Abstract
Objective To explore the changes and significance of peripheral blood polymorphonuclear leukocyte cluster of differentiation 64(CD64)index,soluble urokinase-type plasminogen activator receptor(su-PAR)and interleukin-6(IL-6)in leukemia patients with granulocytopenia and infection after chemotherapy.Methods A retrospective study was conducted to select 50 leukemia patients with agranulocy-tosis and infection after chemotherapy in the Department of Hematology,Baiyin First People's Hospital from August 2022 to August 2023 as the in-fection group,and 59 leukemia patients with agranulocytosis but no infection after chemotherapy were selected as the control group.CD64 index,the levels of su-PAR and IL-6 in the two groups were compared before chemotherapy(T0),after chemotherapy(T1),and during infection(T2)in the infected group.The value of CD64,su-PAR and IL-6 in the diagnosis of agranulocytosis with infection after leukemia chemothera-py was analyzed using the receiver operating characteristic(ROC)curve model.And the changes of CD64 index,the levels of su-PAR and IL-6 in patients with different blood culture results in the infected group and before and after treatment were observed.Results The CD64 index,the levels of su-PAR and IL-6 at T1 and T2 in the two groups were higher than those at T0,and the differences were statistically significant(P＜0.05).The CD64 index at T,and T2 in the infection group were 36.18±5.50 and 46.28±7.84,su-PAR levels were(23.39±4.11)and(29.30±5.13)ng/mL,and IL-6 levels were(37.15±7.63)and(43.49±8.63)ng/L,respectively,which were significantly higher than those in the control group[CD64 index:30.33±4.70,28.61±4.00;su-PAR:(19.63±3.85),(18.26±3.55)ng/mL;IL-6:(29.82±5.86),(27.30±6.61)ng/L],the differences were statistically significant(P＜0.05).The area under the curve of ROC of CD64,su-PAR,IL-6 and the combination of CD64,su-PAR and IL-6 were 0.794,0.734,0.629 and 0.914,respectively.There were 21 patients with positive blood culture bacterial infection and 29 patients with negative blood culture bacterial infection in the infection group.The levels of CD64,su-PAR and IL-6 in the positive patients were significantly higher than those in the negative patients,the differences were statistically significant(P＜0.05).After chemotherapy,patients with leukemic agranulocytosis accompanied with infection were given anti-infection thera-py,and the CD64 index,the levels of su-PAR and IL-6 at the 3rd and 7th day of treatment were significantly lower than those at the 1 st day of treatment,the differences were statistically significant(P＜0.05).Conclusion CD64 index,the levels of su-PAR and IL-6 in peripheral blood of patients with leukemic agranulocytosis associated with infection after chemotherapy are significantly increased,and there are significant re-lationship between positive blood cultures and the occurrence of agranulocytosis associated with infection after chemotherapy.Early combined detec-tion of these three indicators has good diagnostic sensitivity and specificity.
维普
万方数据