降钙素原在血液病化疗后粒细胞缺乏伴发热患者中的应用价值

目的：探讨在血液病化疗后粒细胞缺乏伴发热患者中降钙素原（PCT）的表现与部分病原体的关系。方法：对2010—07—2012—09我院住院部血液科化疗后中性粒细胞缺乏伴发热患者242例资料进行回顾性分析，根据病原学、影像学、症状等，把患者分为感染性发热组和不明原因发热组，感染性发热组又分细菌感染发热亚组、非细菌感染发热亚组，对比分析各组的PCT阳性率水平差异，计算PCT对血培养结果的敏感性。结果：PCT在不明原因发热组中阳性（≥0．5ng／m1）率9．3％，在细菌感染发热亚组阳性率69．2％，在非细菌感染发热亚组阳性率34．5％。在血培养阳性结果中，PCT阳性率显著增高（83．3％），PCT敏感度为85．7％，阴性预测值95．7％。结论：在血液病化疗后中性粒细胞缺乏伴发热诊断中，PCT可作为细菌感染的初步筛选指标，还可作为排除血液细菌感染的指标，以此推断病原体、明确发热原因，针对性地指导临床用药治疗。

Applied value evaluation of procalcitonin in agranulocytosis patients with fever after chemotherapy of blood disease

Objective：To reveal the relationship between procalcitonin （PCT） level and pathogens in agranulo- cytosis patients with fever after chemotherapy of blood disease. Method： A total of 242 agranulocytosis patients with fever after chemotherapy of blood disease were collected in our hospital during Jul 2010 to Sep 2012. Samples were divided into infectious fever group and FUO group according to characteristics of the etiology,imaging,and symptoms. And the infectious fever group included bacterial and non-bacterial infections subgroup. Then, compared the difference of PCT level among groups, and analyzed the effect of the PCT on blood culture result. Result：9.3 samples in FUO group were PCT positive （≥0.5 ng/ml）,while 69.2% samples in bacterial infections fever sub- group were PCT positive. 34. 5% samples in non-bacterial infections fever subgroup were PCT positive. For the blood culture results,PCT positive rate significantly increased （83.3%）. And the sensitivity of PCT was 85.7% with negative predictive value of 95.7 %. Conclusion：PCT could be used as a preliminary indicator of bacterial in- fections fever in the diagnosis of agranulocytosis with fever. And it also could be used to eliminate bacterial infec- tions in blood,help to identify pathogens and infer the reasons of fever. Thus, this will be beneficial to guide the clinical medication treatments of agranulocytosis with fever after chemotherapy of blood disease.