利用ROC曲线分析降钙素原、超敏C反应蛋白对诊断恶性血液病患者化学治疗后早期细菌感染的临床意义

发布时间：2018-06-30 01:42

本文选题：感染 + 化学治疗　；参考：《新乡医学院》2017年硕士论文

【摘要】：背景恶性血液病患者化学治疗后极易发生细菌感染,是影响血液病患者病死率的重要因素,也是血液科常见的危急重症,感染的早期诊断尤为重要。目前感染的诊断主要取决于临床医师的临床经验的判断,通常根据血常规中白细胞数目、中性粒细胞绝对值判断是否感染,但恶性血液病患者化疗药物治疗后白细胞及中性粒细胞数目降低,对细菌及毒素的反应性差,而传统血培养阳性率较低,无助于感染的早期诊断,因此急需寻找快速而可靠的实验室指标来协助恶性血液病化学治疗后细菌感染的早期诊断。目的探讨血清单独检测降钙素原(Procalcitonin,PCT)、超敏C反应蛋白(high sensitive C-reactive protein,hs-CRP)以及两者的联合检测在诊断血液系统恶性疾病患者化学治疗后早期细菌感染中的临床意义。方法应用ROC曲线分析PCT、hs-CRP及PCT+hs-CRP联合诊断的曲线下面积、特异度、灵敏度,以及PCT、hs-CRP的最佳阈值。分析比较PCT、hs-CRP及PCT+hs-CRP三者的阳性预测值、阴性预测值、准确度。结果PCT、hs-CRP、PCT+hs-CRP曲线下面积分别是0.845(95%CI0.779-0.911)、0.719(95%CI0.639-0.798)、0.819(95%CI0.748-0.890)。PCT、hs-CRP的最佳阈值分别为0.955 ng/ml、23.4mg/L;在该阈值下,PCT对应的的灵敏度、特异度分别为90.0%、67.6%,hs-CRP的灵敏度、特异度分别为70.7%、57.2%,PCT的灵敏度及特异度均优于hs-CRP;PCT联合hs-CRP诊断的联合灵敏度、联合特异度分别为63.8%、86.4%。PCT、hs-CRP、PCT+hs-CRP的阳性预测值分别为90.7%、85.2%、94.3%,阴性预测值分别为65.8%、35.6%、40.5%,准确度分别为85.0%、64.7%、68.9%。结论1.PCT用于临床诊断恶性血液病化疗后细菌感染的的最佳阈值为0.955 ng/ml,hs-CRP为23.4mg/L。2.PCT的灵敏度、特异度、阳性预测值、阴性预测值、准确度均高于hs-CRP,可作为恶性血液病化疗后早期细菌感染诊断的可靠指标。3.PCT联合hs-CRP检测的阳性结果在诊断血液系统恶性疾病化学治疗后细菌感染更有意义。
[Abstract]:Background bacterial infection is easy to occur in patients with malignant hematologic diseases after chemotherapy. It is an important factor that affects the mortality of patients with hematologic diseases, and it is also a common critical disease in hematology. The early diagnosis of infection is particularly important. At present, the diagnosis of infection mainly depends on the clinician's clinical experience, usually according to the number of leukocytes in blood routine, the absolute value of neutrophil. However, the number of leukocytes and neutrophils in patients with malignant hematologic diseases decreased after chemotherapy, and the reaction to bacteria and toxins was poor, while the positive rate of traditional blood culture was low, which was not helpful for the early diagnosis of infection. Therefore, it is urgent to search for rapid and reliable laboratory indicators to assist in the early diagnosis of bacterial infection after chemotherapy for malignant hematological diseases. Objective to investigate the clinical significance of the detection of procalcitonin (PC), (high sensitive C-reactive protein (hs-CRP) and their combination in the diagnosis of early bacterial infection in patients with hematological malignancies after chemotherapy. Methods the area, specificity, sensitivity, and the optimal threshold of PCThs-CRP were analyzed by ROC curve in the combined diagnosis of PCT hs-CRP and PCT hs-CRP. The positive predictive value, negative predictive value and accuracy of PCT hs-CRP and PCT hs-CRP were analyzed and compared. Results the area under the PCT hs-CRP curve was 0.845 (95CI0.779-0.911) 0.719 (95CI0.639-0.798) 0.819 (95CI0.748-0.890). The optimum threshold of PCTHs-CRP was 0.955 ng / ml 23.4mgLL.The sensitivity of PCT was 90.067.6hs-CRP, and the specificity was 90.067.6hs-CRP, respectively. The sensitivity and specificity of PCT were 70.7 and 57.2, respectively, which were superior to those of hs-CRPnPCT combined with hs-CRP, and the combined specificity was 63.8and 86.4. the positive predictive value of hs-CRP was 90.785.22 / 94.3, and the negative predictive value was 65.835 / 35.6 / 40.5, respectively, and the accuracy was 85.04.7/ 64.7. Conclusion 1. The optimal threshold of PCT for clinical diagnosis of bacterial infection after chemotherapy is 0.955 ng / ml / ml 路hs-CRP = 23.4mg / L 路PCT sensitivity, specificity, positive predictive value, negative predictive value. 2. The accuracy of hs-CRPwas higher than that of hs-CRP.It could be used as a reliable index for the diagnosis of early bacterial infection after chemotherapy. 3. The positive results of PCT combined with hs-CRP were more significant in the diagnosis of bacterial infection after chemotherapy of malignant diseases of the blood system.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733

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