CRP与PCT和SAA对恶性肿瘤化疗后细菌性感染的诊断价值

目的分析C-反应蛋白(CRP)、降钙素原(PCT)以及血清淀粉样蛋白A(SAA)在恶性肿瘤化疗后细菌性感染的诊断价值。方法回顾性收集2017年1月-2019年12月于天津市北辰医院肿瘤科接受化疗的108例恶性肿瘤化疗后感染患者及同期50例恶性肿瘤化疗未感染患者临床资料,分别纳入感染组及未感染组。比较两组一般资料、血清因子水平、不同感染类型血清因子水平及各项检测方法诊断价值。结果感染组患者细菌感染46例、病毒感染40例以及混合感染22例;感染组患者血清CRP、PCT、SAA、白细胞介素-6(IL-6)、IL-8分别为(71.24±8.18)mg/L、(3.52±0.45)μg/ml、(239.46±20.55)mg/L、(98.35±9.69)ng/L、(249.06±38.57)ng/L高于未感染组患者(P<0.05)。细菌感染患者和混合感染患者血清CRP、PCT、SAA、IL-6、IL-8分别为(101.95±13.04)mg/L、(6.78±0.70)μg/ml、(362.77±39.65)mg/L、(115.94±12.57)ng/L、(351.86±42.09)ng/L和(93.65±14.95)mg/L、(5.82±1.73)μg/ml、(313.59±42.33)mg/L、(99.87±14.24)ng/L、(295.11±49.10)ng/L均高于病毒感染患者(P<0.05);细菌感染及混合感染患者血清因子指标差异无统计学意义。CRP、SAA诊断恶性肿瘤化疗后感染具有较高的灵敏度,联合诊断具有较高的诊断特异性、阳性预测值。结论血清CRP、PCT、SAA、IL-6、IL-8在恶性肿瘤化疗并发感染患者中表达水平升高,在细菌感染及混合感染患者中表达水平高于病毒感染患者,各项因子单独及联合诊断对恶性肿瘤化疗后合并细菌性感染具有一定鉴别价值,可为其诊断及治疗临床提供参考依据。

Analysis of the diagnostic value of CRP,PCT and SAA in bacterial infection after chemotherapy for malignant tumors

OBJECTIVE To analyze the diagnostic value of C reactive protein(CRP)、procalcitonin(PCT) and serum amyloid A(SAA) levels in bacterial infection after chemotherapy for malignant tumors. METHODS The clinical data of 108 patients with chemotherapy-infected malignant tumor and 50 patients who were not infected by chemotherapy with malignant tumors during the same period in oncology department of Beichen hospital from Jan. 2017 to Dec. 2019 were collected retrospectively, and were included in the infected group and the uninfected retrospectively. The general information of the two groups, the serum factor levels of the two groups, serum factor level of different infection types and diagnostic value of various detection methods were compared. RESULTS There were 46 cases of bacterial infection, 40 cases of viral infection and 22 cases of mixed infection in the infected group. Serum CRP, PCT, SAA, interleukin-6(IL-6) and interleukin-8(IL-8) levels in the infection group were(71.24±8.18) mg/L,(3.52±0.45) μg/ml,(239.46±20.55) mg/L,(98.35±9.69) ng/L, and(249.06±38.57) ng/L, respectively, significantly higher than those in the control group(P<0.05). The serum CRP, PCT, SAA, IL-6 and IL-8 levels in the bacterial infection group and mixed infection group were(101.95±13.04) mg/L,(6.78±0.70) μg/ml,(362.77±39.65) mg/L,(115.94±12.57) ng/L,(351.86±42.09) ng/L and(93.65±14.95) mg/L,(5.82±1.73) μg/ml,(313.59±42.33) mg/L,(99.87±14.24) ng/L, and(295.11±49.10) ng/L, respectively, significantly higher than those in the viral infection group(P<0.05). There was no significant difference in serum factor index between patients with bacterial infection and mixed infection group. CRP and SAA had high sensitivity in the diagnosis of malignant tumors infection after chemotherapy, and the combined diagnosis had high diagnostic specificity with positive predictive value. CONCLUSION The expression levels of serum CRP, PCT, SAA, IL-6, IL-8 were elevated in patients with malignant tumor chemotherapy complicated by infection, and the expression level in patients with bacterial and mixed infection were higher than those in patients with viral infection. The individual and combined diagnosis of various factors had certain differential value for the the diagnosis and treatment of malignant tumors with bacterial infections after chemotherapy, and can provide clinical reference for its diagnosis and treatment.