刘剑峰 刘陈菁 付强 刘洋

【摘要】 目的：探討降钙素原（procalcitonin， PCT）、网织血小板百分数（reticulated platelet percent， RP%）、C反应蛋白（C reactive protein， CRP）在白血病合并肺部感染预后评估中的价值。方法：选取2010年1月-2019年12月于本院就诊的白血病合并肺部感染患儿60例作为研究组，另选取同期于本院进行健康体检的健康儿童50例作为对照组。以入院当日为起点，入院3个月或患儿死亡为终点，将研究组患儿分为存活组23例和死亡组37例。所有患儿均进行对症支持和抗生素治疗，检测并比较各组血清PCT、RP%、CRP水平。结果：研究组PCT、RP%、CRP水平均显著高于对照组，差异均有统计学意义（P<0.05）。第1、5、9天，死亡组PCT、RP%、CRP水平均显著高于存活组，差异均有统计学意义（P<0.05）。死亡组PCT、RP%、CRP水平随着时间的延长而逐渐升高，存活组PCT、RP%、CRP水平在第5天达到高峰，而后其水平开始下降，差异均有统计学意义（P<0.05）。PCT、RP%、CRP联合检测的敏感度、AUC均高于单一指标检测。结论：联合检测PCT、RP%、CRP水平对白血病合并肺部感染患儿预后评估具有较好的临床应用价值。

【关键词】 降钙素原 网织血小板 C反应蛋白 白血病 肺部感染

[Abstract] Objective： To investigate the prognostic value of procalcitonin （PCT）， reticulated platelet percent （RP%） and C reactive protein （CRP） in patients with leukemia complicated with pulmonary infection. Method： A total of 60 children with leukemia complicated with pulmonary infection in our hospital from January 2010 to December 2019 were selected as the study group， and 50 healthy children who received physical examination in our hospital during the same period were selected as the control group. The children in the study group were divided into the survival group （n=23） and the death group （n=37）， starting from the day of admission and ending at 3 months after admission or death. All children received symptomatic support and antibiotic treatment. Serum PCT， RP% and CRP levels in each group were detected and compared. Result： The levels of PCT， RP% and CRP in the study group were significantly higher than those in the control group， with statistical significance （P<0.05）. On day 1， 5 and 9， the levels of PCT， RP% and CRP in the death group were significantly higher than those in the survival group， with statistical significance （P<0.05）. The levels of PCT， RP% and CRP in the death group increased gradually with the extension of time， while the levels of PCT， RP% and CRP in the survival group reached the peak on the 5th day and then began to decline， with statistical significance （P<0.05）. The sensitivity， AUC of combined detection of PCT， RP% and CRP were higher than those of single index detection. Conclusion： Combined detection of PCT， RP% and CRP levels has good clinical application value in prognosis assessment of children with leukemia complicated with pulmonary infection.

[Key words] Procalcitonin Reticulated platelet C reactive protein Leukemia Pulmonary infection

First-authors address： Shenzhen Hospital of Southern Medical University， Shenzhen 518000， China

doi：10.3969/j.issn.1674-4985.2021.09.016

白血病（leukemia）是一类造血干细胞克隆性的疾病，在儿童中具有较高的发病率，严重威胁了儿童的身体健康和生存质量。相关研究表明，白血病患儿还会继发感染，而肺部感染是其中最为常见的一种，不仅会加重患儿的病情，而且不利于患儿的预后，是导致患儿死亡的一个主要原因[1]。而早期诊断、早期治疗能够明显提高患儿的临床有效率，因此，早期、准确、快速的诊断和预后评估方法在临床中显得尤为重要。

目前临床多采用炎性因子对患者进行早期诊断以及预后评估，并且具有较高的特异性和敏感度。而相关研究数据表明，降钙素原（procalcitonin， PCT）在炎性感染反应的早期诊断、病情严重程度以及预后的评估等方面要明显优于其他炎性指标[2-3]。但只依靠PCT对患者进行诊断和评估预后，其不足明显，因此在临床中更倾向于同时检测多个指标[4]。……