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复旦大学附属肿瘤医院麻醉科重症监护室,复旦大学上海医学院肿瘤学系,上海,200032
网络出版:2016-06-13,
纸质出版:2016-06-13
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张忠伟,申丽华,傅凤鸣,等. 降钙素原在化疗致粒细胞减少伴发热患者中的临床意义[J]. 中国癌症杂志, 2016, 26(3): 263-267.
张忠伟, 申丽华, 傅凤鸣. The clinical value of procalcitonin in patients with chemotherapy-induced febrile neutropenia[J]. China Oncology, 2016, 26(3): 263-267.
张忠伟,申丽华,傅凤鸣,等. 降钙素原在化疗致粒细胞减少伴发热患者中的临床意义[J]. 中国癌症杂志, 2016, 26(3): 263-267. DOI: 10.3969/j.issn.1007-3969.2016.03.010.
张忠伟, 申丽华, 傅凤鸣. The clinical value of procalcitonin in patients with chemotherapy-induced febrile neutropenia[J]. China Oncology, 2016, 26(3): 263-267. DOI: 10.3969/j.issn.1007-3969.2016.03.010.
背景与目的:以往研究显示血清降钙素原可用于发热性疾病的诊断及其严重程度的评估。该研究旨在探讨血清降钙素原在化疗致粒细胞减少伴发热患者中的临床意义。方法:回顾性分析2012年1月—2014年12月以化疗致粒细胞减少伴发热收入复旦大学附属肿瘤医院ICU治疗的147例患者的临床资料。根据患者临床症状、体征、病原生物学特征确定患者有无感染,进而分为感染组及发热原因不详组。根据患者感染严重程度又将感染组分为脓毒症组、严重脓毒症组及脓毒性休克组,分析比较各组血清降钙素原的变化。结果:降钙素原大于0.935 ng/mL为临界值诊断粒细胞减少伴感染患者的敏感度为90.5%,特异度为90.0%,曲线下面积为0.905。感染组与发热原因不详组比较,降钙素原显著增高[1.805(1.268~2.523) ng/mL vs 0.555(0.398~0.818) ng/mL,P0.001]。亚组分析表明,严重脓毒症组与脓毒症组比较,血清降钙素原水平明显增高[13.885(7.600~17.961) ng/mL vs 1.805(1.268-2.563) ng/mL,P0.001];脓毒性休克组血清降钙素原水平显著高于严重脓毒症组[23.800(20.050~30.478) ng/mL vs 13.885(4.955~19.133) ng/mL,P0.001]。结论:血清降钙素原检测可用于粒细胞减少伴感染患者的诊断及感染严重程度的判断。
Background and purpose: Previous researches have shown that procalcitonin differentiates infectious from non-infectious fever and assesses the severity of infectious diseases. This study aimed to investigate the clinical value of procalcitonin in patients with chemotherapy-induced febrile neutropenia. Methods: A total of 147 patients with chemotherapy-induced febrile neutropenia admitted to intensive care unit from Jan. 2012 to Dec. 2014 were divided into infectious group and fever of unknown origin group according to clinical symptoms
signs and etiology. The infectious group was divided into sepsis
severe sepsis
and septic shock groups according to the severity of infection. The procalcitonin levels were compared between different groups. Results: A procalcitonin cut-off value0.935 ng/mL provided a sensitivity of 90.0%
specificity of 90.0% and AUC=0.905. The procalcitonin level of the infectious group was significantly higher than that of the fever of unknown origin group [1.805 (1.268-2.523) ng/mL vs 0.555 (0.398-0.818) ng/mL
P0.001]. There is a significant difference between the severe sepsis group and the sepsis group [13.885 (7.600-17.961) ng/mL vs 1.805 (1.268-2.563) ng/mL
P0.001]. Compared with the severe sepsis group
the value of procalcitonin in the septic shock group was significantly higher [23.800 (20.050-30.478) ng/mL vs 13.885 (4.955-19.133) ng/mL
P0.001]. Conclusion: Plasma procalcitonin is a useful marker for diagnosing neutropenia in patients with infection. Meanwhile
procalcitonin can be used to assess the severity of infection in patients with neutropenia.
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