降钙素原对肺癌患者发热的临床意义

Clinical value of procalcitonin in febrile patients with lung cancer

摘要:

目的 探讨降钙素原(Pct)、白细胞(WBC)、中性粒细胞比例(N)和高敏C-反应蛋白(hs-CRP)对肺癌患者发热的临床意义。方法 纳入2013年6月至2018年1月在首都医科大学石景山教学医院北京市石景山医院肿瘤科住院的发热肺癌患者共113例,依据发热原因分为2组:炎性发热组(n=71)和肿瘤热组(n=42)。其中炎性发热组又分为2个亚组:败血症亚组(n=28)和非败血症亚组(n=43)。同期纳入20例无发热以及感染的肺癌患者作为对照组。所有患者均于入院后以及感染控制后抽血进行Pct、WBC、N以及hs-CRP检测。采用SPSS 16.0统计软件进行数据分析。不同变量间相关性使用Spearman分析。受试者工作特征(ROC)曲线分析Pct对诊断肺癌发热患者感染的价值。结果 炎性发热组患者的Pct水平显著高于肿瘤热组(Z=5.101,P<0.001)和对照组(Z=5.169,P<0.001),非败血症亚组的Pct水平显著高于肿瘤热组(Z=4.334,P<0.001)。在炎性发热组中,Pct与WBC(r=0.352,P=0.003)、N(r=0.385,P=0.001)和hs-CRP(r=0.427,P=0.002)呈显著正相关。炎性发热组以肿瘤热组为参照时,Pct的AUC为0.907(95％CI 0.833～0.982),最佳截断点为0.53 ng/ml,灵敏度和特异度分别为0.833和0.857。结论 Pct在肺癌患者中鉴别肿瘤热和炎性发热具有较高的诊断价值。

Abstract:

Objective To evaluate procalcitonin (Pct), white blood cell(WBC), neutrophil percentage(N), and high sensitivity C-reactive protein(hs-CRP) in the diagnosis of febrile patients with lung cancer. Methods A total of 113 febrile patients with lung cancer were enrolled in the study, who were treated in the Department of Oncology of Shijingshan Hospital. Based on the causes of fever, the patients were divided into fever-induced-by-inflammation (FIBI) group (n=71) and fever-induced-by-tumor (FIBT) group (n=42). The former was further divided into the sepsis subgroup (28 cases) and non-sepsis subgroup (43 cases). Also enrolled in the study as control group were 20 patients with lung cancer without fever and inflammation, who were treated during the same period. Blood samples were obtained for Pct, WBC, N and hs-CRP after their admission to the hospital and cure of infection. SPSS statistics 16.0 was used for data analysis. Spearman analysis was performed to investigate the relationships between variables. Receiver operating characteristic (ROC) curve was adopted to analyze the value of Pct in diagnosis of infection in febrile patients with lung cancer. Results Pct was significantly higher in the FIBI group than both the FIBT group (Z=5.101, P<0.001) and the control group(Z=5.169, P<0.001), and it was also significantly higher in non-sepsis group than in the FIBT group (Z=4.334, P<0.001). Pct was positively correlated with WBC (r=0.352, P=0.003), N (r=0.385, P=0.001), and hs-CRP (r=0.427, P=0.002) in the FIBI group. Using FIBT group as control, area under ROC curve (AUC) of Pct for the FIBI group was 0.907(95％CI 0.833-0.982), with the optimal cutoff value being 0.53 ng/ml, a sensitivity of 0.833 and a specificity of 0.857. Conclusion Pct is valuable in the differential diagnosis of fever induced by tumor and inflammation in the patients with lung cancer.