降钙素原、中性粒细胞CD64、内毒素检测联合细菌培养对化疗后脓毒症诊断的价值
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摘要
目的探讨降钙素原、中性粒细胞CD64、内毒素检测联合细菌培养对非小细胞肺癌化疗后脓毒症诊断的价值。方法根据细菌培养结果,将100例非小细胞肺癌化疗后脓毒症患者分为化疗后革兰阳性杆菌血流感染所致脓毒症患者(G~+菌组,n=57)、化疗后革兰阴性杆菌血流感染所致脓毒症患者(G~-菌组,n=43),另选取30例化疗后未发生脓毒症的患者作为对照组(n=30)。分别采用双抗体夹心免疫发光法、流式细胞学原理、动态比浊法测定三组受试患者血清降钙素原水平、中性粒细胞表面CD64阳性百分率以及内毒素水平,通过绘制ROC曲线评估降钙素原、中性粒细胞CD64、内毒素单独及联合预测化疗后G~+菌、G~-菌血流感染所致脓毒症的灵敏度以及特异性。结果对照组受试患者血清降钙素原水平、中性粒细胞表面CD64阳性百分率、内毒素水平均明显低于G~+菌组以及G~-菌组(P <0. 05),G~+菌组上述指标明显低于G~-菌组,且3组受试患者间差异有统计学意义(P <0. 05)。ROC曲线分析结果显示,降钙素原、中性粒细胞表面CD64阳性百分率、内毒素三者联合预测化疗后G~+菌、G~-菌血流感染所致脓毒症时,曲线下面积为0. 851,灵敏度与特异性分别为80. 2%和88. 2%,联合预测化疗后G~-菌血流感染所致脓毒症时,曲线下面积为0. 896,灵敏度与特异性分别为82. 1%和96. 2%。结论检测血清降钙素原、中性粒细胞表面CD64、内毒素水平有利于化疗后脓毒症的诊断并能够对G~+菌、G~-菌血流感染所致脓毒症进行鉴别,三者联合诊断的灵敏度及特异性均高于单独检测其中一种。
Objective To investigate the value of calcitonin,neutrophil CD64,endotoxin detection combined with bacterial culture in diagnosis of sepsis after chemotherapy in patients with non small cell lung cancer( NSCLC). Methods According to the results of bacterial culture,100 patients with NSCLC who sufffered from sepsis caused by blood stream infection after chemotherapy were divided into gram positive bacilli bloodstream infection group( G~+ bacteria group,n = 57)and gram negative bacilli bloodstream infection group( G~- bacteria group,n = 43). In addition,30 patients who did not suffered from sepsis after chemotherapy were enrolled as the control group. The levels of procalcitonin,neutrophil CD64 surface positive percentage and endotoxin were detected by immune luminescence method,the principle of fluid cytology,dynamic turbidimetric method,respectively. Moreover the ROC curve was drawn to evaluate the sensitivity and specificity of procalcitonin,neutrophil CD64,simple endotoxin or endotoxin detection combined with bacterial culture in diagnosis of sepsis after chemotherapy.Results The levels of serum procalcitonin,neutrophil CD64 surface positive percentage and endotoxin in control group were significantly lower than those in G~+ bacteria group and G~- bacteria group( P < 0. 05),moreover,which in G~+ bacteria group were significantly lower than those in G~-bacterium group( P < 0. 05). ROC curve analysis results showed that the area under the curve,sensitivity and specificity by combiunation detection of procalcitonin,neutrophil CD64 surface positive percentage and endotoxin after chemotherapy in diagnosis of sepsis caused by G~+ bacteria were 0. 851,80. 2% and 88. 2%,respectively,and which by G~- bacteria were 0. 896,82. 1% and 96. 2%,respectively. Conclusion The detection of serum procalcitonin,neutrophil CD64 surface,endotoxin levels is helpful for the diagnosis of sepsis after chemotherapy,which is able to identify sepsis caused by G+bacteria or G~- bacteria bloodstream infection,moreover,the diagnostic sensitivity and specificity by combination detection of the three indexes are higher than those by single detection.
Objective To investigate the value of calcitonin,neutrophil CD64,endotoxin detection combined with bacterial culture in diagnosis of sepsis after chemotherapy in patients with non small cell lung cancer( NSCLC). Methods According to the results of bacterial culture,100 patients with NSCLC who sufffered from sepsis caused by blood stream infection after chemotherapy were divided into gram positive bacilli bloodstream infection group( G~+ bacteria group,n = 57)and gram negative bacilli bloodstream infection group( G~- bacteria group,n = 43). In addition,30 patients who did not suffered from sepsis after chemotherapy were enrolled as the control group. The levels of procalcitonin,neutrophil CD64 surface positive percentage and endotoxin were detected by immune luminescence method,the principle of fluid cytology,dynamic turbidimetric method,respectively. Moreover the ROC curve was drawn to evaluate the sensitivity and specificity of procalcitonin,neutrophil CD64,simple endotoxin or endotoxin detection combined with bacterial culture in diagnosis of sepsis after chemotherapy.Results The levels of serum procalcitonin,neutrophil CD64 surface positive percentage and endotoxin in control group were significantly lower than those in G~+ bacteria group and G~- bacteria group( P < 0. 05),moreover,which in G~+ bacteria group were significantly lower than those in G~-bacterium group( P < 0. 05). ROC curve analysis results showed that the area under the curve,sensitivity and specificity by combiunation detection of procalcitonin,neutrophil CD64 surface positive percentage and endotoxin after chemotherapy in diagnosis of sepsis caused by G~+ bacteria were 0. 851,80. 2% and 88. 2%,respectively,and which by G~- bacteria were 0. 896,82. 1% and 96. 2%,respectively. Conclusion The detection of serum procalcitonin,neutrophil CD64 surface,endotoxin levels is helpful for the diagnosis of sepsis after chemotherapy,which is able to identify sepsis caused by G+bacteria or G~- bacteria bloodstream infection,moreover,the diagnostic sensitivity and specificity by combination detection of the three indexes are higher than those by single detection.
引文
1王启船,王青,屈中玉,等.老年非小细胞肺癌患者放化疗治疗期医院感染的危险因素研究.中华医院感染学杂志,2017,27:5109-5112.
2陆珊珊,陈晨,孙路,等.老年非小细胞肺癌患者化疗后感染病原菌耐药性与易感因素分析.中华医院感染学杂志,2015,25:5329-5331.
3林白桦,贾勇士,毕爱红,等.局部晚期非小细胞肺癌患者同步放化疗医院感染的病原学分析及预防.中华医院感染学杂志,2012,22:3506-3508.
4兰守丽.胸腺肽α1对老年非小细胞肺癌患者化疗期间感染风险及预后的影响.中华临床医师杂志(电子版),2016,8:2414-2418.
5吴丽丽,郭海飞,蔡啸静,等.老年非小细胞肺癌放化疗患者医院感染病原菌耐药性分析.中华医院感染学杂志,2016,26:2921-2923.
6孙彩萍,陈遐林,朱晓灵,等.紫龙金片治疗晚期非小细胞肺癌患者化疗后感染的临床观察.中华医院感染学杂志,2014,24:4493-4497.
7陈春荣,宋爱英,高玉艳,等.晚期小细胞肺癌患者时辰化疗期医院感染分析.中华医院感染学杂志,2015,25:1085-1087.
8王炳平,李方华,朱增宽,等.非小细胞肺癌患者化疗期间医院感染的相关因素分析.中华医院感染学杂志,2016,26:4692-4694.
9 Neumann S,Krause SW,Maschmeyer G,et al.Primary prophylaxis o bacterial infections and Pneumocystis jirovecii pneumonia in patients with hematological malignancies and solid tumors:guidelines of the Infectious Diseases Working Party(AGIHO)of the German Society of Hematology and Oncology(DGHO).Ann Hematol,2013,92:433-442.
10 Freifeld AG,Bow EJ,Sepkowitz KA,et al.Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer:2010update by the infectious diseases society of america.Clin Infect Dis,2011,52:e56-e93.
11 Pokala HR,Leonard D,Cox J,et al.Association of hospital construction with the development of healthcare associated environmental mold infections(HAEMI)in pediatric patients with leukemia.Pediatr Blood Cancer,2014,61:276-280.
12 Duane TM,Kikhia RM,Wolfe LG,et al.Understanding Gramnegative Central Line-Associated Blood Stream Infection in a Surgical Trauma ICU.Am Surg,2015,81:816-819.
13 Dimoula A,Pradier O,Kassengera Z,et al.Serial determinations of neutrophil CD64 expression for the diagnosis and monitoring of sepsis in critically ill patients.Clin Infect Dis,2014,58:820-829.
14 Huang E,Yousef AE,et al.Paenibacterin,a novel broad-spectrum lipopeptide antibiotic,neutralises endotoxins and promotes survival in a murine model of Pseudomonas aeruginosa-induced sepsis.Int JAntimicrob Agents,2014,44:74-77.
15 Surez-Santamaria M,Santolaria F,Perez-Ramirez A.Prognostic value of inflammatory markers(notably cytokines and procalcitonin),nutritional assessment,and organ function in patients with sepsis.Eur Cytokine Netw,2010,21:19-26.
16 Guidry CA,Rosenberger LH,Petroze RT,et al.Temporal trends in blood stream infection isolates from surgical patients.Surg Infect(Larchmt),2015,16:388-395.
17 Mancardi DA,Albanesi M,J9nsson F,et al.The high-affinity human Ig Greceptor FcγRI(CD64)promotes Ig G-mediated inflammation,anaphylaxis,and antitumor immunotherapy.Blood,2013,121:1563-1573.
18 Jia LQ,Shen YC,Hu QJ,et al.Diagnostic accuracy of neutrophil CD64expression in neonatal infection:a meta-analysis.J Int Med Res,2013,41:934-943.
19 Ronco C.Lipopolysaccharide(LPS)from the cellular wall of Gramnegative bacteria,also known as endotoxin,is a key molecule in the pathogenesis of sepsis and septic shock.Preface.Blood Purif,2014,37:1.
20 Biagioni E,Venturelli C,Klein DJ,et al.Endotoxin activity levels as a prediction tool for risk of deterioration in patients with sepsis not admitted to the intensive care unit:a pilot observational study.J Crit Care,2013,28:612-617.
2陆珊珊,陈晨,孙路,等.老年非小细胞肺癌患者化疗后感染病原菌耐药性与易感因素分析.中华医院感染学杂志,2015,25:5329-5331.
3林白桦,贾勇士,毕爱红,等.局部晚期非小细胞肺癌患者同步放化疗医院感染的病原学分析及预防.中华医院感染学杂志,2012,22:3506-3508.
4兰守丽.胸腺肽α1对老年非小细胞肺癌患者化疗期间感染风险及预后的影响.中华临床医师杂志(电子版),2016,8:2414-2418.
5吴丽丽,郭海飞,蔡啸静,等.老年非小细胞肺癌放化疗患者医院感染病原菌耐药性分析.中华医院感染学杂志,2016,26:2921-2923.
6孙彩萍,陈遐林,朱晓灵,等.紫龙金片治疗晚期非小细胞肺癌患者化疗后感染的临床观察.中华医院感染学杂志,2014,24:4493-4497.
7陈春荣,宋爱英,高玉艳,等.晚期小细胞肺癌患者时辰化疗期医院感染分析.中华医院感染学杂志,2015,25:1085-1087.
8王炳平,李方华,朱增宽,等.非小细胞肺癌患者化疗期间医院感染的相关因素分析.中华医院感染学杂志,2016,26:4692-4694.
9 Neumann S,Krause SW,Maschmeyer G,et al.Primary prophylaxis o bacterial infections and Pneumocystis jirovecii pneumonia in patients with hematological malignancies and solid tumors:guidelines of the Infectious Diseases Working Party(AGIHO)of the German Society of Hematology and Oncology(DGHO).Ann Hematol,2013,92:433-442.
10 Freifeld AG,Bow EJ,Sepkowitz KA,et al.Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer:2010update by the infectious diseases society of america.Clin Infect Dis,2011,52:e56-e93.
11 Pokala HR,Leonard D,Cox J,et al.Association of hospital construction with the development of healthcare associated environmental mold infections(HAEMI)in pediatric patients with leukemia.Pediatr Blood Cancer,2014,61:276-280.
12 Duane TM,Kikhia RM,Wolfe LG,et al.Understanding Gramnegative Central Line-Associated Blood Stream Infection in a Surgical Trauma ICU.Am Surg,2015,81:816-819.
13 Dimoula A,Pradier O,Kassengera Z,et al.Serial determinations of neutrophil CD64 expression for the diagnosis and monitoring of sepsis in critically ill patients.Clin Infect Dis,2014,58:820-829.
14 Huang E,Yousef AE,et al.Paenibacterin,a novel broad-spectrum lipopeptide antibiotic,neutralises endotoxins and promotes survival in a murine model of Pseudomonas aeruginosa-induced sepsis.Int JAntimicrob Agents,2014,44:74-77.
15 Surez-Santamaria M,Santolaria F,Perez-Ramirez A.Prognostic value of inflammatory markers(notably cytokines and procalcitonin),nutritional assessment,and organ function in patients with sepsis.Eur Cytokine Netw,2010,21:19-26.
16 Guidry CA,Rosenberger LH,Petroze RT,et al.Temporal trends in blood stream infection isolates from surgical patients.Surg Infect(Larchmt),2015,16:388-395.
17 Mancardi DA,Albanesi M,J9nsson F,et al.The high-affinity human Ig Greceptor FcγRI(CD64)promotes Ig G-mediated inflammation,anaphylaxis,and antitumor immunotherapy.Blood,2013,121:1563-1573.
18 Jia LQ,Shen YC,Hu QJ,et al.Diagnostic accuracy of neutrophil CD64expression in neonatal infection:a meta-analysis.J Int Med Res,2013,41:934-943.
19 Ronco C.Lipopolysaccharide(LPS)from the cellular wall of Gramnegative bacteria,also known as endotoxin,is a key molecule in the pathogenesis of sepsis and septic shock.Preface.Blood Purif,2014,37:1.
20 Biagioni E,Venturelli C,Klein DJ,et al.Endotoxin activity levels as a prediction tool for risk of deterioration in patients with sepsis not admitted to the intensive care unit:a pilot observational study.J Crit Care,2013,28:612-617.