目的:探讨血清C反应蛋白(C-reactive protein, CRP)、降钙素原(procalcitonin, PCT)、血常规中性粒细胞计数(neutrophil count, NC)和中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio, NLR)联合检测在肿瘤患者感染性疾病早期鉴别诊断中的应用价值。方法:收集2022年8月-2023年9月于江苏省肿瘤医院内科、胸外科治疗的335例化疗发热患者的临床资料以及CRP、PCT、NC和NLR数据。分析细菌感染组、真菌感染组和非感染组间CRP、PCT、NC和NLR水平,评价各指标在鉴别肿瘤发热患者诊断中的价值。结果:335例肿瘤发热患者标本培养出阳性细菌66例,阳性真菌34例,阳性率为29.9%;病原体以白假丝酵母菌比例最高,其次为金黄色葡萄球菌、大肠埃希菌和肺炎克雷伯菌。细菌感染组、真菌感染组和非感染组在年龄、NLR、病理类型方面差异无统计学意义(P＞0.05),在性别、CRP方面差异有统计学意义(P＜0.05)。细菌感染组与非感染组相比,PCT、NC差异有统计学意义(P＜0.05)。三组患者血清PCT值分别为(6.11±16.14)、(1.87±4.23)、(2.32±13.19)ng/mL,均高于正常参考值1.5 ng/mL,CRP值分别为(81.56±69.20)、(64.06±60.27)、(60.51±60.07)mg/L,均高于正常参考值10 mg/L。PCT、CRP诊断肿瘤患者细菌感染性发热与非细菌感染性发热的CRP灵敏度高,而PCT特异性最高,ROC曲线下面积(area under the curve, AUC)分别为0.575、0.628。结论:结合PCT、CRP血清标志物的特点,联合检测可鉴别肺癌化疗患者发热的原因,反映细菌感染性疾病患者病情进展程度,指导临床合理用药。
Objective: To investigate the application value of combined detection of serum C-reactive protein (CRP), procalcitonin (PCT), blood routine neutrophil count (NC) and neutrophil to lymphocyte ratio (NLR) in the early differential diagnosis of bacterial infectious diseases. Methods: The clinical data, CRP, PCT, NC and NLR of 335 patients with chemotherapy fever who were treated in the Department of Internal Medicine and Department of Thoracic Surgery of Jiangsu Cancer Hospital from August 2022 to September 2023 were collected. Analyze the levels of CRP, PCT, NC,and NLR among the bacterial infection group, fungal infection group, and non-infection group, and evaluate the value of each indicator in the differential diagnosis of fever patients. Results: There were 66 cases of positive bacteria and 34 cases of positive fungi in the specimens of 335 patients with cancer fever, with a positive rate of 29.9%. The proportion of Candida albicans was the highest, followed by Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae. There was no significant difference in age, NLR and pathological type between bacterial infection group, fungal infection group and non-infection group (P＞0.05), but there was significant difference in gender and CRP (P＜0.05). There were significant differences in PCT and NC between the bacterial infection group and the non-infection group (P＜0.05). The serum PCT values of the three groups were (6.11±16.14) ng/mL, (1.87±4.23) ng/mL and (2.32±13.19) ng/mL, respectively, which were higher than the normal reference value of 1.5 ng/mL. The CRP values were (81.56±69.20) mg/L, (64.06±60.27) mg/L and (60.51±60.07) mg/L, respectively, which were higher than the normal reference value of 10 mg/L. PCT and CRP had high sensitivity in diagnosing CRP of bacterial infectious fever and non-bacterial infectious fever in cancer patients, while PCT had the highest specificity, and the area under the curve (AUC) was 0.575 and 0.628, respectively. Conclusion: Combined with the characteristics of PCT and CRP serum markers, combined detection can identify the causes of fever in patients with lung cancer chemotherapy, reflect the degree of disease progression in patients with bacterial infectious diseases, and guide clinical rational drug use.
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