發(fā)布時間：2018-06-30 01:42

  本文選題：感染 + 化學治療�。� 參考：《新鄉(xiāng)醫(yī)學院》2017年碩士論文

【摘要】：背景惡性血液病患者化學治療后極易發(fā)生細菌感染,是影響血液病患者病死率的重要因素,也是血液科常見的危急重癥,感染的早期診斷尤為重要。目前感染的診斷主要取決于臨床醫(yī)師的臨床經驗的判斷,通常根據(jù)血常規(guī)中白細胞數(shù)目、中性粒細胞絕對值判斷是否感染,但惡性血液病患者化療藥物治療后白細胞及中性粒細胞數(shù)目降低,對細菌及毒素的反應性差,而傳統(tǒng)血培養(yǎng)陽性率較低,無助于感染的早期診斷,因此急需尋找快速而可靠的實驗室指標來協(xié)助惡性血液病化學治療后細菌感染的早期診斷。目的探討血清單獨檢測降鈣素原(Procalcitonin,PCT)、超敏C反應蛋白(high sensitive C-reactive protein,hs-CRP)以及兩者的聯(lián)合檢測在診斷血液系統(tǒng)惡性疾病患者化學治療后早期細菌感染中的臨床意義。方法應用ROC曲線分析PCT、hs-CRP及PCT+hs-CRP聯(lián)合診斷的曲線下面積、特異度、靈敏度,以及PCT、hs-CRP的最佳閾值。分析比較PCT、hs-CRP及PCT+hs-CRP三者的陽性預測值、陰性預測值、準確度。結果PCT、hs-CRP、PCT+hs-CRP曲線下面積分別是0.845(95%CI0.779-0.911)、0.719(95%CI0.639-0.798)、0.819(95%CI0.748-0.890)。PCT、hs-CRP的最佳閾值分別為0.955 ng/ml、23.4mg/L;在該閾值下,PCT對應的的靈敏度、特異度分別為90.0%、67.6%,hs-CRP的靈敏度、特異度分別為70.7%、57.2%,PCT的靈敏度及特異度均優(yōu)于hs-CRP;PCT聯(lián)合hs-CRP診斷的聯(lián)合靈敏度、聯(lián)合特異度分別為63.8%、86.4%。PCT、hs-CRP、PCT+hs-CRP的陽性預測值分別為90.7%、85.2%、94.3%,陰性預測值分別為65.8%、35.6%、40.5%,準確度分別為85.0%、64.7%、68.9%。結論1.PCT用于臨床診斷惡性血液病化療后細菌感染的的最佳閾值為0.955 ng/ml,hs-CRP為23.4mg/L。2.PCT的靈敏度、特異度、陽性預測值、陰性預測值、準確度均高于hs-CRP,可作為惡性血液病化療后早期細菌感染診斷的可靠指標。3.PCT聯(lián)合hs-CRP檢測的陽性結果在診斷血液系統(tǒng)惡性疾病化學治療后細菌感染更有意義。
[Abstract]:Background bacterial infection is easy to occur in patients with malignant hematologic diseases after chemotherapy. It is an important factor that affects the mortality of patients with hematologic diseases, and it is also a common critical disease in hematology. The early diagnosis of infection is particularly important. At present, the diagnosis of infection mainly depends on the clinician's clinical experience, usually according to the number of leukocytes in blood routine, the absolute value of neutrophil. However, the number of leukocytes and neutrophils in patients with malignant hematologic diseases decreased after chemotherapy, and the reaction to bacteria and toxins was poor, while the positive rate of traditional blood culture was low, which was not helpful for the early diagnosis of infection. Therefore, it is urgent to search for rapid and reliable laboratory indicators to assist in the early diagnosis of bacterial infection after chemotherapy for malignant hematological diseases. Objective to investigate the clinical significance of the detection of procalcitonin (PC), (high sensitive C-reactive protein (hs-CRP) and their combination in the diagnosis of early bacterial infection in patients with hematological malignancies after chemotherapy. Methods the area, specificity, sensitivity, and the optimal threshold of PCThs-CRP were analyzed by ROC curve in the combined diagnosis of PCT hs-CRP and PCT hs-CRP. The positive predictive value, negative predictive value and accuracy of PCT hs-CRP and PCT hs-CRP were analyzed and compared. Results the area under the PCT hs-CRP curve was 0.845 (95CI0.779-0.911) 0.719 (95CI0.639-0.798) 0.819 (95CI0.748-0.890). The optimum threshold of PCTHs-CRP was 0.955 ng / ml 23.4mgLL.The sensitivity of PCT was 90.067.6hs-CRP, and the specificity was 90.067.6hs-CRP, respectively. The sensitivity and specificity of PCT were 70.7 and 57.2, respectively, which were superior to those of hs-CRPnPCT combined with hs-CRP, and the combined specificity was 63.8and 86.4. the positive predictive value of hs-CRP was 90.785.22 / 94.3, and the negative predictive value was 65.835 / 35.6 / 40.5, respectively, and the accuracy was 85.04.7/ 64.7. Conclusion 1. The optimal threshold of PCT for clinical diagnosis of bacterial infection after chemotherapy is 0.955 ng / ml / ml 路hs-CRP = 23.4mg / L 路PCT sensitivity, specificity, positive predictive value, negative predictive value. 2. The accuracy of hs-CRPwas higher than that of hs-CRP.It could be used as a reliable index for the diagnosis of early bacterial infection after chemotherapy. 3. The positive results of PCT combined with hs-CRP were more significant in the diagnosis of bacterial infection after chemotherapy of malignant diseases of the blood system.
【學位授予單位】：新鄉(xiāng)醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R733

【參考文獻】

相關期刊論文 前10條

1 郭翠花;;48例白血病化療后肛周感染的護理[J];中國衛(wèi)生標準管理;2016年04期

2 徐雪梅;吳思穎;謝軼;陳知行;馬瑩;何超;康梅;;耐萬古霉素腸球菌血流感染的危險因素分析[J];中國感染與化療雜志;2015年05期

3 郭淑利;;老年血液病患者醫(yī)院感染的臨床分析[J];中國實用醫(yī)藥;2015年15期

4 羅彥;程紅霞;鄭媛;;白血病合并口腔感染的護理體會[J];臨床醫(yī)藥實踐;2015年05期

5 何牧卿;朱寶玲;何牧群;林曉驥;郭文堅;;惡性血液病患者醫(yī)院感染革蘭陽性菌的變化[J];中華醫(yī)院感染學雜志;2015年08期

6 王亞華;祝永明;邵平揚;吳曉燕;宋秀蘭;陳松勁;馮雪君;;產超廣譜β-內酰胺酶大腸埃希菌的耐藥性分析[J];中華醫(yī)院感染學雜志;2015年06期

7 黃勛;鄧子德;倪語星;鄧敏;胡必杰;李六億;李家斌;周伯平;王選錠;宗志勇;劉正印;任南;李衛(wèi)光;鄒明祥;徐修禮;周建英;侯鐵英;鮮于舒銘;胡成平;艾宇航;王玉寶;秦秉玉;劉進;吳佳玉;鄭波;孫樹梅;趙鳴雁;吳安華;;多重耐藥菌醫(yī)院感染預防與控制中國專家共識[J];中國感染控制雜志;2015年01期

8 方莉;;急性白血病化療后肛周感染的原因分析及護理干預[J];中國實用醫(yī)藥;2014年33期

9 徐葉進;范順富;郭玉香;付躍娟;;敗血癥患者病原菌分布及耐藥性分析[J];中華醫(yī)院感染學雜志;2014年17期

10 楊柳;舒航;吳冠宇;谷和先;張波;洪有軍;鄧娜;;139例惡性血液病患者院內感染的回顧性分析[J];皖南醫(yī)學院學報;2014年04期

，

本文編號：2084295