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目的探讨血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)及二者联合检测对诊断恶性血液病患者化学治疗后早期感染的临床意义。方法选择2015年7月至2016年6月在新乡医学院第一附属医院住院的恶性血液病化学治疗后疑似感染的患者167例,检测血清PCT、hs-CRP水平,应用受试者工作特征(ROC)曲线分析并比较PCT、hs-CRP及PCT+hs-CRP诊断恶性血液病患者化学治疗后早期感染的曲线下面积、特异度、灵敏度、阳性预测值、阴性预测值及准确度。结果 PCT、hs-CRP及PCT+hs-CRP诊断恶性血液病患者化学治疗后早期感染的曲线下面积分别为0.845、0.719、0.819,三者比较差异均有统计学意义(P<0.05)。PCT诊断恶性血液病患者化学治疗后早期感染的灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为90.0%、67.6%、90.7%、65.8%、85.0%,hs-CRP诊断恶性血液病患者化学治疗后早期感染的灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为70.7%、57.2%、85.2%、35.6%、64.7%,PCT+hs-CRP诊断恶性血液病患者化学治疗后早期感染的灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为63.8%、86.4%、94.3%、40.5%、68.9%。PCT诊断恶性血液病患者化学治疗后早期感染的灵敏度、特异度、阳性预测值、阴性预测值及准确度均优于hs-CRP(P<0.05)。PCT+hs-CRP诊断恶性血液病患者化学治疗后早期感染的特异度高于PCT、hs-CRP(P<0.05);PCT+hs-CRP诊断恶性血液病患者化学治疗后早期感染的灵敏度稍低于PCT、hs-CRP,但差异无统计学意义(P>0.05)。PCT+hs-CRP诊断恶性血液病患者化学治疗后早期感染的阴性预测值及准确度均低于PCT(P<0.05),阳性预测值高于PCT(P<0.05);PCT+hs-CRP诊断恶性血液病患者化学治疗后早期感染的阳性预测值、阴性预测值及准确度均高于hs-CRP(P<0.05)。结论 PCT诊断恶性血液病患者化学治疗后早期感染优于hsCRP;PCT联合hs-CRP诊断恶性血液病患者化学治疗后早期感染的特异度优于二者单独诊断。
Objective To investigate the clinical significance of serum procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP) and their combined detection in the diagnosis of early infection after chemotherapy in patients with hematological malignancies. Methods From July 2015 to June 2016, 167 patients with suspected infection after malignant hemorrhagic disease were hospitalized in the First Affiliated Hospital of Xinxiang Medical College from January 2015 to June 2016. Serum PCT and hs-CRP levels were measured and the subjects’ working characteristics ROC curve analysis and to compare the area, specificity, sensitivity, positive predictive value, negative predictive value and accuracy of PCT, hs-CRP and PCT + hs-CRP in patients with hematological malignancies after chemotherapy. Results The area under the curve of early infection after chemotherapy of PCT, hs-CRP and PCT + hs-CRP in patients with hematologic malignancies were 0.845, 0.719 and 0.819, respectively. There were significant differences among the three groups (P <0.05). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PCT in early diagnosis of hematologic malignancies after chemotherapy were 90.0%, 67.6%, 90.7%, 65.8% and 85.0%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of early infection after chemotherapy were 70.7%, 57.2%, 85.2%, 35.6% and 64.7% respectively. The diagnosis of hematological malignancies with PCT + hs-CRP The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of early infection after chemotherapy were 63.8%, 86.4%, 94.3%, 40.5% and 68.9%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PCT in early diagnosis of hematologic malignancies after chemotherapy were better than hs-CRP (P <0.05). The specificity of early detection of PCT + hs-CRP in patients with hematologic malignancies after chemotherapy was higher than that of PCT and hs-CRP (P <0.05). The sensitivity of PCT + hs-CRP in early diagnosis of hematological malignancies after chemotherapy was slightly lower In PCT, hs-CRP, but the difference was not statistically significant (P> 0.05). The negative predictive value and accuracy of PCT + hs-CRP in patients with hematologic malignancies after chemotherapy were lower than that of PCT (P <0.05), the positive predictive value was higher than that of PCT (P <0.05); PCT + hs-CRP diagnosis The positive predictive value, negative predictive value and accuracy of early infection after chemotherapy in patients with hematologic malignancies were higher than those of hs-CRP (P <0.05). Conclusions Early diagnosis of malignant hematological diseases after PCT is superior to hsCRP in the diagnosis of hematologic malignancies. The specificity of PCT combined with hs-CRP in early diagnosis of hematological malignancies after chemotherapy is better than that of hsCRP alone.