急性白血病感染患者炎症因子、凝血指标及血小板参数的相关性分析
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摘要
目的分析急性白血病感染患者血清中炎症因子、凝血指标及血小板参数的变化及其相关性。方法收集急性白血病患者120例分为未感染组、普通感染组与脓毒症组。对以上3组的炎症因子、凝血指标及血小板参数进行检测和比较。结果普通感染组及脓毒症组患者血清中超敏C-反应蛋白(hs-CRP)、降钙素原(PCT)、CD64阳性率、部分凝血酶原时间(APTT)、凝血酶原时间(PT)、D-二聚体(D-D)、纤维蛋白原(FIB)、血小板平均体积(MPV)、血小板分布宽度(PDW)及大血小板比率(P-LCR)水平均显著高于未感染组,抗凝血酶Ⅲ(AT-Ⅲ)及血小板计数(PLT)水平显著低于未感染组;且随着感染程度加重,变化趋势愈明显,差异有统计学意义(P<0.05)。结论急性白血病化疗后并发败血症患者凝血功能异常与血液细菌性感染炎症反应密切相关,脓毒血症患者的感染炎症水平、并发凝血功能异常的风险均显著高于非脓毒血症组。
Objective To analyze the changes and correlation between inflammatory factors, coagulation parameters and platelet parameters in patients with acute leukemia. Methods 120 patients with acute leukemia were collected and divided into uninfected group, infection group and sepsis group. The serum levels of inflammatory factors, coagulation parameters and platelet parameters were detected and analyzed. Results The rates of hypersensitive C-reactive protein(hs-CRP), procalcitonin(PCT), CD64, partial prothrombin time(APTT), prothrombin time(PT), D-Dimer(D-D), fibrinogen(FIB), mean platelet volume(MPV), plateletdistribution width(PDW) and platelet-large cell ratio(P-LCR) in infection group and sepsis group were significantly higher than those in the uninfected group, and the level of antithrombin Ⅲ(AT-Ⅲ) and platelet count(PLT) was significantly lower than that in the uninfected group. The rates of hs-CRP, PCT, CD64, APTT, PT, D-Dimer, FIB, MPV, PDW and P-LCR in sepsis group were significantly higher than those in the common infection group, and the levels of antithrombin Ⅲ and PLT were significantly lower than that in the infection group. It increased with the severity of infections, and the differences were statistically significant(P<0.05). Conclusion The abnormal coagulation function in patients with acute leukemia after chemotherapy is closely related to the inflammatory response of blood bacterial infection, the cellular level of inflammation and risk of concurrent coagulation in patients with sepsis infection are significantly higher than non-sepsis patients.
Objective To analyze the changes and correlation between inflammatory factors, coagulation parameters and platelet parameters in patients with acute leukemia. Methods 120 patients with acute leukemia were collected and divided into uninfected group, infection group and sepsis group. The serum levels of inflammatory factors, coagulation parameters and platelet parameters were detected and analyzed. Results The rates of hypersensitive C-reactive protein(hs-CRP), procalcitonin(PCT), CD64, partial prothrombin time(APTT), prothrombin time(PT), D-Dimer(D-D), fibrinogen(FIB), mean platelet volume(MPV), plateletdistribution width(PDW) and platelet-large cell ratio(P-LCR) in infection group and sepsis group were significantly higher than those in the uninfected group, and the level of antithrombin Ⅲ(AT-Ⅲ) and platelet count(PLT) was significantly lower than that in the uninfected group. The rates of hs-CRP, PCT, CD64, APTT, PT, D-Dimer, FIB, MPV, PDW and P-LCR in sepsis group were significantly higher than those in the common infection group, and the levels of antithrombin Ⅲ and PLT were significantly lower than that in the infection group. It increased with the severity of infections, and the differences were statistically significant(P<0.05). Conclusion The abnormal coagulation function in patients with acute leukemia after chemotherapy is closely related to the inflammatory response of blood bacterial infection, the cellular level of inflammation and risk of concurrent coagulation in patients with sepsis infection are significantly higher than non-sepsis patients.
引文
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[15] 李未今.PCT、Fb 和CRP 检测在感染性疾病诊断中的应用[J].放射免疫学杂志,2013,26(6):799-801.
[2] 杨敬敬,李焱.老年急性白血病病人化疗后骨髓抑制期感染的临床分析[J].实用老年医学,2017,31(3):253-256.
[3] 王桂云,阎丽华,陈兆红,等.急性白血病患儿与血清IL-10、IFN-γ水平的相关性[J].湖南师范大学学报:医学版,2015(2):91-93.
[4] Vand PT,Levi M.Crosstalk between inflammation and coagulation:the lessons of sepsis[J].Curr Vasc Pharmacol,2012,10(5):632-638.
[5] O'Brien M.The reciprocal relationship between inflammation and coagulation[J].Top Companion Anim Med,2012,27(2):46-52.
[6] 张之南,沈悌.血液病诊断及疗效标准[M].3版.北京:科学出版社,2007:232-235.
[7] 唐昊,刘冬,张画羽,等.三版国际脓毒症诊断标准诊断效能分析[J].解放军医学杂志,2016,41(4):295-300.
[8] 吴志雄,冯坤好,谭家余,等.小剂量肝素钠与低分子肝素钙对脓毒症治疗作用的对比研究[J].临床和实验医学杂志,2016,15(4):359-361.
[9] Ades L,Prebet T,Stamatoullas A,et al.Lenalidomide combined with intensive chemotherapy in acute myeloid leukemia and higher-risk myelodysplastic syndrome with 5q deletion.Results of a phase II study by the Groupe Francophone Des Myélodysplasies[J].Haematologica,2016,102(4):728.
[10] 熊丹,李末娟.急性白血病化疗后并发败血症患者凝血功能异常与感染相关指标的关系及临床意义的分析[J].中国医学创新,2015,12(32):33-36.
[11] 杨爱景,王波,李桂霞,等.动态监测白血病化疗后粒缺期合并感染患者血清炎性因子水平变化的临床意义[J].中华医院感染学杂志,2016,26(19):4395-4397.
[12] Hatzistilianou M,Rekliti A,Athanassiadou F,et al.Procalcitonin as an early marker of bacterial infection in neutropenic febrile children with acute lymphoblastic leukemia[J].Inflamm Res,2010,59(5):339-347.
[13] Gerrits JH,Mclaughlin PM,Nienhuis BN,et al.Polymorphic mononuclear neutrophils CD64 index for diagnosis of sepsis in postoperative surgical patients and critically ill patients[J].Clin Chem Lab Med,2013,51(4):897-905.
[14] 赵翠,顾小红,聂玉坡.急性白血病合并感染患者CRP和D二聚体水平变化及临床诊断价值分析[J].检验医学,2016,31(b09):106-107.
[15] 李未今.PCT、Fb 和CRP 检测在感染性疾病诊断中的应用[J].放射免疫学杂志,2013,26(6):799-801.