摘要
目的观察急性白血病化疗后发热患儿外周血多型核白细胞CD64指数和血清细胞因子白细胞介素(interleukin,IL)-6、-2、-4、-10及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、γ-干扰素(interferon-γ,IFN-γ)表达情况,探讨CD64指数和细胞因子在儿童急性白血病化疗后中性粒细胞缺乏伴发热诊疗中的作用及临床意义。方法152例急性白血病化疗后中性粒细胞缺乏患儿,根据是否发热分为发热组121例和未发热组31例,检测2组入院2 h外周血CD64指数和细胞因子IL-6、IL-2、IL-4、IL-10、TNF-α、IFN-γ水平,并进行比较;绘制ROC曲线,评估CD64指数和IL-6对急性白血病化疗后中性粒细胞缺乏伴发热的诊断效能。发热组治疗36 h后98例进行疗效评估,并根据疗效分为治疗有效组75例和疗效不佳组23例,比较2组治疗前、后CD64指数和IL-6水平。结果入院2 h时,发热组患儿CD64指数[58.84(18.06,182.49)]、IL-6[54.38(17.49,139.86)ng/L]水平高于未发热组[7.90(1.81,31.81)、21.11(11.41,39.12)ng/L](P<0.05),IL-2、IL-4、IL-10、TNF-α、IFN-γ水平与未发热组比较差异均无统计学意义(P>0.05)。入院2 h血清IL-6、CD64指数最佳截断值为29.0 ng/L、12.06时,诊断急性白血病化疗后中性粒细胞缺乏并发热的AUC分别为0.839(95%CI:0.766~0.941,P<0.001)、0.817(95%CI:0.731~0.918,P<0.001),灵敏度分别为77.6%、85.7%,特异度分别为92.3%、57.7%。入院2 h时,治疗有效组患儿CD64指数[88.78(38.82,187.39)]和IL-6水平[131.70(44.91,337.98)ng/L]与疗效不佳组[60.00(34.37,190.69)、172.49(37.23,237.90)ng/L]比较差异均无统计学意义(P>0.05);治疗36 h时,治疗有效组患儿CD64指数[55.37(24.11,149.76)]和IL-6水平[45.89(20.34,136.74)ng/L]低于入院2 h时(P<0.05),疗效不佳组IL-6水平[378.48(103.75,765.66)ng/L]高于入院2 h时(P<0.05),CD64指数[67.38(52.91,223.54)]与入院2 h时比较差异均无统计学意义(P>0.05);治疗36 h时,治疗有效组CD64指数和IL-6水平明显低于疗效不佳组(P<0.05)。结论IL-6和CD64指数对急性白血病化疗后粒细胞缺乏并发热患儿具有较好的诊断效能,动态检测CD64指数和IL-6有助于指导儿童急性白血病化疗后粒细胞缺乏并发热的规范化诊治。
Objective To observe the expressions of polymorphonuclear CD64 index in perigeral blood,and serum cytokines as interleukin(IL)-6,IL-2,IL-4,IL-10,tumor necrosis factor-α(TNF-α)and interferon-γ(IFN-γ),and to investigate the roles of CD64 index and cytokines in the diagnosis and treatment of neutropenic fever after chemotherapy in pediatric acute leukemia patients.Methods Totally 152 neutropenic patients with pediatric acute leukemia were divided into 121 patients with neutropenic fever(fever group)and 31 patients without neutropenic fever after chemotherapy(no-fever group).The CD64 index,and the levels of IL-2,IL-4,IL-6,IL-10,TNF-α and IFN-γ were detected in 2 h after admission,and were conpared between two groups.ROC was drawn to evaluate the diagnostic efficacies of CD64 index and IL-6 on neutropenic fever after treatment.In fever group,98 patients were evaluated the therapeutic effect after treatment for 36 h,by which fever group was redivided into effective treatment group(n=75)and ineffective treatment group(n=23),and the CD64 index and the IL-6 level were compared between two groups before and after treatment.Results In 2 hafter admission,the CD64 index and IL-6 level were higher in fever group(58.84(18.06,182.49),54.38(17.49,139.86)ng/L)than those in no-fever group(7.90(1.81,31.81),21.11(11.41,39.12)ng/L)(P<0.05),and the levels of IL-2,IL-4,IL-10,TNF-α and IFN-γ showed no significant differences between two groups(P>0.05).When the optimal cut-offvalues of IL-6 and CD64 index in 2 hafter admission were 29.0 ng/L and 12.06,the AUCs for diagnosing neutropenic fever were 0.839(95%CI:0.766-0.941,P<0.001)and 0.817(95%CI:0.731-0.918,P<0.001),with the sensitivities of 77.6% and 85.7%,and the specificities of 92.3% and 57.7%.The CD64 index and IL-6 level showed no significant differences between effective group(88.78(38.82,187.39),131.70(44.91,337.98)ng/L)and ineffective group(60.00(34.37,190.69),172.49(37.23,237.90)ng/L)in 2 h after admission(P>0.05),which were higher than those after 36-h treatment in effective group(CD64 index:55.37(24.11,149.76),IL-6:45.89(20.34,136.74)ng/L)(P<0.05).The IL-6 level was higher after 36-h treatment(378.48(103.75,765.66)ng/L)than that in 2 hafter admission in ineffective group(P<0.05),and the CD64 index showed no significant difference after 36-h treatment(67.38(52.91,223.54))compared with that in 2 hafter admission(P>0.05).The CD64 index and IL-6 level were lower in effective group than those in ineffective group after 36-h treatment(P<0.05).Conclusion IL-6 and CD64 index have high efficacies on neutropenic fever after chemotherapy,and the dynamical monitoring of CD64 index and IL-6 level contributes to the guidance of standardized therapy of neutropenic fever after chemotherapy in children with acute leukemia.
作者
杨李
卢文婕
张爱萍
王卓
张兰男
熊昊
YANG Li;LU Wenjie;ZHANG Aiping;WANG Zhuo;ZHANG Lannan;XIONG Hao(Department of Hematology,Wuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430016,China;School of Medicine of Jianghan University,Wuhan 430056,China)
出处
《中华实用诊断与治疗杂志》
2020年第12期1274-1277,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
湖北省卫计委面上项目(WJ2017M195)。
