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

目的 分析白血病感染患者血清超敏C反应蛋白(hs-CRP)、降钙素原(PCT)水平及血小板参数的变化及其相关性。方法 回顾性的分析2016年2月至2019年8月首都医科大学宣武医院血液科收治的白血病患者86例,根据感染程度的不同分为三组,即未感染组26例,轻微感染组44例,脓毒症组16例。对比分析三组患者血清中hsCRP、PCT及D-二聚体(D-D)、凝血酶原时间(PT)、纤维蛋白原(FIB)、血小板平均体积(MPV)、血小板分布宽度(PDW)及大血小板比率(P-LCR)抗凝血酶原Ⅲ(AT-Ⅲ)。结果 轻微感染组及脓毒症组患者的白细胞(WBC)、血红蛋白、红细胞(RBC)均显著低于未感染组,差异具有统计学意义(P <0. 05)。轻微感染组及脓毒症组患者的hsCRP、PCT、PT、D-D、MPV、P-LCR、PDW、FIB显著高于未微感染组(P <0. 05),AT-Ⅲ、PLT则明显低于未感染组(P<0. 05);另外脓毒症组患者的hs-CRP(103. 65±5. 04) mg/L]、PCT(0. 86±0. 04)μg/L]、PT(16. 83±2. 47) s]、D-D(5. 92±0. 61) mg/L]、FIB(5. 97±0. 63) g/L]、MPV(25. 65±2. 06) fl]、P-LCR13. 76±0. 63)%]、PDW(68. 53±0. 72)%]均显著高于轻微感染组,AT-Ⅲ(76. 62±8. 06)μg/L]、PLT(142. 65±14. 76)×109/L]则明显低于轻微感染组;上述差异均具有统计学意义(P <0. 05)。ROC受试者工作特征曲线(ROC曲线)显示,PCT的曲线下面积(AUC)值(0. 978)高于hs-CRP(0. 864)。脓毒症患者PCT与PT、MPV、PDW、P-LCR(r+0. 256;0. 473;0. 546;0. 472)呈正相关关系,与AT-Ⅲ、PLT(r+0. 366;-0. 603)呈负相关关系(P <0. 05)。PCT与D-D、FIB(r=0. 054,0. 075)无明显的相关关系。结论 白血病感染患者血清PCT水平明显异常,且血清中PCT与hs-CRP、血小板参数存在密切关系。检测血清PCT水平可以为白血病感染患者的治疗及预后判断提供依据。

Correlation factors of serum hs-CRP,PCT and platelet parameters in patients with leukemia infection

Objective To analyze the changes of serum high sensitive C-reactive Protein(hs-CRP),procalcitonin(PCT)and platelet parameters in patients with leukemia infection.Methods 86 leukemia patients in department of Hematology,Xuanwu Hospital,Capital Medical University from February 2016 to August 2019 were retrospectively analyzed.The patients were divided into three groups according to the degree of infection,26 cases in the uninfected group,44 cases in the mild infected group and 16 cases in the sepsis group.The serum hs-CRP,PCT and D-Dimer(D-D),prothrombin time(PT),D-Dimer(D-D),fibrinogen(FIB),mean platelet volume(MPV),platelet distribution width(PDW)and large platelet ratio(P-LCR)antithrombinⅢ(ATⅢ)in the three groups were compared and analyzed.Results White blood cell(WBC),hemoglobin,red blood cell(RBC)of patients in the mild infection group and sepsis group were significantly lower than those in the uninfected group(P<0.05).The levels of hs-CRP,PCT,PT,D-D,MPV,P-LCR,PDW and FIB in mild infection group and sepsis group were significantly higher than those in non-mild infection group,in addition,the levels of hs-CRP(103.65±5.04)mg/L],PCT(0.86±0.04)μg/L],PT(16.83±2.47)]s,D-D(5.92±0.61)]mg/L,FIB(5.97±0.63)]g/L,MPV(25.65±2.06)fl,]P-LCR(13.76±0.63)%],PDW(68.53±0.72)%]in sepsis group were significantly higher than those in mild infection group,in contrast,AT-Ⅲ(76.62±8.06),PLT(142.65±14.76)were significantly lower than those in mild infection group.they were all P<0.05.The ROC(Display of working characteristic curve of subjects)curve showed that the AUC(Area enclosed by coordinate axis under ROC curve)value of PCT was 0.978,which was higher than hs-CRP.PCT was positively correlated with PT,MPV,PDW,P-LCR(The R values were 0.256;0.473;0.546;0.472,respectively),and negatively correlated with AT-Ⅲand PLT(The R values were 0.366 and-0.603,respectively)in septic patients(P<0.05).There was no significant correlation between PCT and D-D or FIB.Conclusion There is a close relationship between serum PCT and hs-CRP,platelet parameters in patients with leukemia infection.In addition,the abnormality of serum hs-CRP,PCT and platelet parameters in patients with sepsis is obvious.It can provide a basis for the treatment and prognosis.