降钙素原与骨髓移植后菌血症患者感染菌群特点及预后的相关性

doi:10.3969/j.issn.1006-7795.2021.05.006

摘要/Abstract

摘要： 目的分析197例骨髓移植后菌血症患者感染菌群特点及血清指标的变化情况,探讨了降钙素原(procalcitonin,PCT)与骨髓移植后患者全身感染及预后的相关性。方法纳入197例骨髓移植后菌血症患者,收集其临床资料、血培养结果、检测炎症及生物化学指标。根据患者是否粒细胞缺乏、感染细菌类型、感染部位及感染预后分别将患者分组。比较各组各项指标的变化情况,分析其临床意义。结果骨髓移植后菌血症患者中,粒细胞缺乏患者的PCT明显高于非粒细胞缺乏患者[1.64(0.25,10.12) ng/mL vs 0.76(0.28,2.72) ng/mL,P<0.05]; 患者感染部位具有免疫低下血液病患者的特点,感染主要集中在肺部、肛周及消化系统,不同感染部位之间PCT差异不明显;K-M生存曲线分析显示随着PCT值的升高,骨髓移植后菌血症患者生存率降低;COX回归分析显示,PCT、肌酐及感染革兰阴性菌是造成骨髓移植后感染死亡的危险因素,白蛋白是其保护因素,差异均有统计学意义。尤其是革兰阴性菌感染是造成死亡的主要危险因素(HR:3.729,95%CI:1.001~13.888,P=0.05),而与是否粒细胞缺乏和感染部位无关。结论在骨髓移植后菌血症患者中,粒细胞缺乏患者 PCT明显升高;随着PCT值的升高及革兰阴性菌的感染,骨髓移植后菌血症患者生存率降低,尤其是革兰阴性菌感染是造成骨髓移植菌血症患者死亡的主要危险因素。

关键词: 降钙素原, 骨髓移植, 菌血症

Abstract: Objective To investigate the correlation between procalcitonin (PCT) and bacterial bloodstream infection in the prediction of systemic bacterial infection and prognosis for the patients after bone marrow transplantation. Methods A total of 197 patients with bacterial bloodstream infection after bone marrow transplantation were enrolled and divided into groups according to whether they had agranulocytosis, type of infected bacteria, site of infection, and prognosis of infection. The clinical data were collected, and the blood culture, inflammation and biochemical indexes were detected. The difference of each index between the groups was compared to analyze its clinical significance. Results The PCT in the patients with granulocytopenia was significantly higher than that without granulocytopenia [PCT:1.64(0.25, 10.12) ng/ mL vs 0.76(0.28, 2.72) ng/ mL, P<0.05]. The infection sites of the patients showed the characteristics of patients with immunocompromised blood diseases. The most common infection sites were lung, perianal and digestive system, with no significant difference in PCT between the different infection sites. K-M survival curve analysis showed that the survival rate of the patients with bacteremia after bone marrow transplantation decreased with the increased of PCT. COX analysis showed that PCT, creatinine (CRE), and infection with gram-negative bacteria were the risk factors for infection and death, while albumin (ALB) was the protective factor (all of which were statistically significant). In particular, the gram-negative bacteria infection was a major risk factor for death (HR:3.729,95%CI:1.001-13.888, P=0.05), regardless of grain deficiency and infection site. Conclusion In patients with bacterial bloodstream infection after bone marrow transplantation, the PCT was significantly increased in patients with granulopathy. With the increase of PCT value and gram-negative bacteria infection, the survival rate of bacteremia patients after bone marrow transplantation decreased. The gram-negative bacteria infection was the main risk factor for death.

Key words: procalcitonin, marrow transplantation, bacteremia

中图分类号:

R446

李珊珊, 鲍会漳, 孙意, 王春燕, 贾玫. 降钙素原与骨髓移植后菌血症患者感染菌群特点及预后的相关性[J]. 首都医科大学学报, 2021, 42(5): 726-732.

Li Shanshan, Bao Huizhang, Sun Yi,Wang Chunyan, Jia Mei. Correlation between procalcitonin and bacterial community characteristics and prognosis of patients with bacteremia after bone marrow transplantation[J]. Journal of Capital Medical University, 2021, 42(5): 726-732.

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