摘要
目的探讨血NAP活性联合HsCRP检测在恶性血液病发热原因鉴别中的临床应用价值。方法对近两年来本科住院的300例恶性血液病伴有发热的患者分析，最后经病原微生物证实为真菌感染28例，细菌感染160例，混合感染47例，非感染者65例（无病原微生物证据，抗生素治疗无效，且给予激素以及原发病治疗有效）。对所有患者发热时常规进行的血NAP活性联合HsCRP进行回顾性分析。结果真菌感染患者的血NAP积分中位数165，阳性率82％，HsCRP水平为12mg／dl，而细菌感染组、混合感染组、非感染组患者的血NAP积分中位数分别为126、147、36，阳性率分别为68％、76％、32％，HsCRP水平分别为11．6mg／dl、10．8mg／dl、0．8mg／dl。恶性血液病患者合并真菌或者细菌抑或混合感染的患者，血NAP活性以及HsCRP水平均明显高于非感染患者，相互比较差异有统计学意义；在合并感染患者当中，真菌感染患者血NAP活性较细菌感染患者升高更为明显，混合感染介于其中，相互比较差异均有统计学意义；HsCRP真菌感染患者略高，但相互比较差异无统计学意义。结论血NAP活性联合HsCRP检测有助于恶性血液病患者发热原因分析，在未获得病原微生物以前，为临床医师治疗是否选择抗生素，以及是否抗真菌治疗提供了有力证据，有利于及早控制感染以及避免不必要的抗生素使用。
Objective To explore the test of serum NAP activity combined with HsCRP in differential diagnosis of fever from hematologic malignancies. Methods 300 cases of hematologic malignancies with fever of our hospital in the last two years were retrospectively analyzed, 28 cases of fungus infection, 160 cases of bacterial infection, 47 eases of polyinfection and 65 cases of none -infectious （no pathogenic microorganism evidence, treatment futility with antibiotics and effective with hormone and primary disease targeted treatment） were confirmed by pathogenic microorganism study, the test results of serum NAP activity combined with HsCRP were retrospectively analyzed. Results The integral median of serum NAP in fungus infection patients was 165, the positive rate was 82%, in - HsCRP level was 12mg/dl, while in bacteria infection, polyinfection and none - infectious patients they were 126,147,36, 68%.76% ,32%, 11. 6mg/dl, 10. 8mg/dl,0. 8mg/dl respectively. The serum NAP and HsCRP level were significantly higher in patients with hematologic malignancies combined with fungus infection or bacteria infection or polyinfection; in patients with infections, the serum NAP was significantly higher in fungus infection than bacteria infection, and polyinfection was in the middle of them. The HsCRP level of fungus infection was higher but of no statistical significance. Conclusions The test of serum NAP activity combined with HsCRP helps in differential diagnosis for reasons for fever from hematologic malignancies, which provides doctors with helpful information in choosing antibiotics and anti - fungal therapy before the confirmation of pathogenic microorganism study, so as to have an early control of infection as well as avoiding unnecessary antibiotic usage.
出处
《浙江临床医学》
2009年第4期363-365,共3页
Zhejiang Clinical Medical Journal
关键词
NAP活性
超敏CRP
恶性血液病
发热原因
鉴别
NAP activity High sensitive C - reactive protein （ hs - CRP） Hematologic malignancy Reason for fever Differential diagnosis
作者简介
在读研究生，现在浙江省台州市第一人民医院工作
