降钙素原和超敏C反应蛋白在诊断恶性血液病患者化学治疗后早期感染中的临床价值

摘要

Objective To explore the clinical significance of serum procalcitonin(PCT),high sensitive C reactive protein(hs-CRP) and PCT combined with hs-CRP in the diagnosis of early infection after chemotherapy in patients with malignant hematologic diseases.Methods One hundred and sixty-seven hematological malignancies patients with suspected infection in the First Affiliated Hospital of Xinxiang Medical University from July 2015 to June 2016 were selected and both the serum levels of PCT and hs-CRP of all patients were detected.The receiver operating characteristic (ROC) curve was used to compare the areas under the curves,specificity,sensitivity,positive predictive value,negative predictive value and accuracy of PCT,hs-CRP and PCT + hs-CRP in diagnosis of early infection in patients with malignant hematologic diseases.Results The area under the ROC curve of the PCT,hs-CRP and PCT + hs-CRP was 0.845,0.719,0.819 respectively;there was statistic difference in the area under the ROC curve among them(P ＜ 0.05).The sensitivity,specificity,positive predictive value,negative predictive value,accuracy of PCT in diagnosis of early infection was 90％,67.6％,90.7％,65.8％,85.0％ respectively;the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of hs-CRP in diagnosis of early infection was 70.7 ％,57.2 ％,85.2 ％,35.6％,64.7 ％ respectively;the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of PCT + hs-CRP in diagnosis of early infection was 63.8％,86.4％,94.3％,40.5％,68.9％ respectivly.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of PCT were better than those of hsCRP (P ＜ 0.05).The specificity of PCT + hs-CRP was higher than that of PCT and hs-CRP(P ＜ 0.05);the sensitivity of PCT + hs-CRP was slightly lower than that of PCT and hs-CRP,but the difference was not statistically significant(P ＞ 0.05).The negative predictive value and accuracy of PCT + hs-CRP in diagnosis of early infection was lower than those of PCT (P ＜ 0.05),the positive predictive value was higher than that of PCT(P ＜ 0.05).The positive predictive value,negative predictive value and accuracy of PCT + hs-CRP in diagnosis of early infection was higher than that of hs-CRP(P ＜ 0.05).Conclusions PCT is superior to hs-CRP in the diagnosis of early infection of hematological malignancies after chemotherapy.The specificity of PCT combined with hs-CRP is better than the single diagnosis of PCT or hs-CRP.%目的 探讨血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)及二者联合检测对诊断恶性血液病患者化学治疗后早期感染的临床意义.方法 选择2015年7月至2016年6月在新乡医学院第一附属医院住院的恶性血液病化学治疗后疑似感染的患者167例,检测血清PCT、hs-CRP水平,应用受试者工作特征(ROC)曲线分析并比较PCT、hs-CRP及PCT+ hs-CRP诊断恶性血液病患者化学治疗后早期感染的曲线下面积、特异度、灵敏度、阳性预测值、阴性预测值及准确度.结果 PCT、hs-CRP及PCT+ hs-CRP诊断恶性血液病患者化学治疗后早期感染的曲线下面积分别为0.845、0.719、0.819,三者比较差异均有统计学意义(P＜0.05).PCT诊断恶性血液病患者化学治疗后早期感染的灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为90.0％、67.6％、90.7％、65.8％、85.0％,hs-CRP诊断恶性血液病患者化学治疗后早期感染的灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为70.7％、57.2％、85.2％、35.6％、64.7％,PCT+ hs-CRP诊断恶性血液病患者化学治疗后早期感染的灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为63.8％、86.4％、94.3％、40.5％、68.9％.PCT诊断恶性血液病患者化学治疗后早期感染的灵敏度、特异度、阳性预测值、阴性预测值及准确度均优于hs-CRP(P ＜0.05).PCT+ hs-CRP诊断恶性血液病患者化学治疗后早期感染的特异度高于PCT、hs-CRP(P ＜0.05);PCT+ hs-CRP诊断恶性血液病患者化学治疗后早期感染的灵敏度稍低于PCT、hs-CRP,但差异无统计学意义(P＞0.05).PCT+ hs-CRP诊断恶性血液病患者化学治疗后早期感染的阴性预测值及准确度均低于PCT(P ＜0.05),阳性预测值高于PCT(P＜0.05);PCT+ hs-CRP诊断恶性血液病患者化学治疗后早期感染的阳性预测值、阴性预测值及准确度均高于hs-CRP(P ＜0.05).结论 PCT诊断恶性血液病患者化学治疗后早期感染优于hs-CRP;PCT联合hs-CRP诊断恶性血液病患者化学治疗后早期感染的特异度优于二者单独诊断.