南方医科大学学报

南方医科大学学报 ›› 2015, Vol. 35 ›› Issue (11): 1535-.

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移植日C反应蛋白水平对异基因造血干细胞移植早期感染及预后的预测意义

沈克锋，刘启发，孙竞，江千里，张钰，周红升，戴敏，肖敏，王瑾，罗莉，李钦璐，安海云，洪振亚，孟力，杨默，周剑峰，王高翔   

  • 出版日期:2015-11-20 发布日期:2015-11-20

Value of C-reactive protein level on transplantation day in predicting early posttransplant
infections and outcomes of allogeneic hematopoietic stem cell transplantation

  • Online:2015-11-20 Published:2015-11-20

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摘要： 目的探讨移植日C反应蛋白（CRP）水平对异基因造血干细胞移植早期败血症等感染事件发生的预测意义。方法回
顾性分析78 例异基因移植患者病例资料，采用受试者工作特征曲线（ROC）评估CRP诊断移植早期败血症的临床参考值及
相应灵敏度和特异度，以所得临床参考值为临界值将病例资料分为低CRP组和高CRP组，分析比较两组间的移植相关并发
症及总生存（OS）和复发率等。结果CRP 诊断移植早期败血症的临床参考值为23.3 mg/L（AUC=0.735，P=0.001，95% CI
0.623~0.848），相应灵敏度和特异度分别为0.793 和0.592；高CRP组粒系平均重建时间较低CRP组延迟0.71 d（P=0.237），巨
核系平均重建时间显著延迟4.09 d（P=0.048）；高CRP组移植早期败血症及巨细胞病毒（CMV）血症发生率较低CRP组显著
增高（53.5% vs 17.1%，P=0.001；72.1% vs 37.1%，P=0.003），但两组间EB病毒（EBV）血症、肺部侵袭性真菌感染及急性移植
物抗宿主病（aGVHD）发生率无统计学差异（41.9% vs 22.9%，P=0.094；14.0% vs 5.7%，P=0.285, 51.2% vs 45.7，P=0.656）；高
CRP 组中位随访318（7~773）d，低CRP 组中位随访299（78~747）d，高CRP 组2 年OS 率较低CRP 组显著降低（42.5% vs
78.4%，P=0.022），高CRP组2 年累计复发率较低CRP组高（52.3% vs 19.8%，P=0.235），但差异无统计学意义；Logistic 多因素
分析显示高CRP水平是移植早期败血症的独立危险因素（OR=5.090，95% CI 1.115~23.229，P=0.036）。结论移植日CRP水
平对异基因造血干细胞移植早期败血症有一定的预测意义，高CRP水平提示较高的移植早期败血症和CMV血症发生率
以及较差的预后。

Abstract: Objective To investigate the value of C-reactive protein (CRP) on transplantation day in predicting early
post-transplant infections and outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods We
retrospectively analyzed the clinical data of 78 recipients undergoing allo-HSCT. The clinical reference value of CRP on
transplantation day was determined, and its sensitivity and specificity for diagnosing bacteremia was analyzed using
receiver-operating characteristic curve (ROC). The incidence of transplant-related complications, overall survival, and relapse
rate of the patients were analyzed with respect to the CRP level. Results The clinical reference value of CRP for diagnosing
bacteremia was 23.3 mg/L (AUC=0.735 [95% CI: 0.623-0.848], P=0.001), which had a diagnostic sensitivity and specificity of
0.793 and 0.592, respectively. Compared with the patients with low CRP levels, the patients with high CRP levels tended to
have delayed neutrophil reconstitution and platelet engraftment by 0.71 days (P=0.237) and 4.09 days (P=0.048), respectively,
and had a significantly higher incidence of bacteremia (17.1% vs 53.5%, P=0.001) and CMV viremia (37.1% vs 72.1%, P=0.003)
within 100 days following the transplantation; the incidences of EBV viremia, pulmonary invasive fungal infection, or acute
graft versus host disease (aGVHD) showed no significant difference between the two groups (41.9% vs 22.9%, P=0.094; 14.0% vs
5.7%, P=0.285; 51.2% vs 45.7, P=0.656, respectively). During the follow-up for a median of 318 (7-773) days in high-CRP group
and for 299 (78-747) days in low-CRP group, the high-CRP group showed a significantly lower 2-year overall survival than the
low-CRP group (42.5% vs 78.4%, P=0.022), and tended to have a higher 2-year cumulative relapse rate (52.3% vs 19.8%, P=
0.235). Logistic multivariate analysis identified a high CRP level on transplantation day as the independent risk factor for
post-transplant bacteremia within 100 days (OR=5.090[95% CI: 1.115 -23.229], P=0.036). Conclusion A high CRP level on transplantation day can be indicative of
a high risk of early post-transplant bacteremia and CMV viremia and also a poor prognosis following allo-HSCT.