Hellmich Bernhard, Csernok Elena, de Haas Masja, von dem Borne Albert E G K R, Schatz Helmut, Gross Wolfgang L, Schnabel Armin
Poliklinik für Rheumatologie, Medizinische Universität zu Lübeck, Germany.
Am J Med. 2002 Aug 1;113(2):134-9. doi: 10.1016/s0002-9343(02)01161-0.
To determine whether serum levels of soluble Fcgamma receptor III and granulocyte colony-stimulating factor (G-CSF) are associated with the risk of infection in patients with neutropenia due to Felty's syndrome or systemic lupus erythematosus.
Serum levels of G-CSF and soluble Fcgamma receptor III were measured by enzyme-linked immunosorbent assays in 13 patients with neutropenia due to Felty's syndrome, 10 patients with neutropenia due to systemic lupus erythematosus, and 41 controls with normal leukocyte counts (25 with systemic lupus erythematosus, 16 with rheumatoid arthritis). We calculated the area under the receiver operating characteristic (ROC) curves for the absolute neutrophil count, soluble Fcgamma receptor III levels, and G-CSF levels.
Nine of the neutropenic patients (7 with Felty's syndrome, 2 with lupus) had one or more infections within 3 months before and after blood samples were obtained. Absolute neutrophil counts were similar in neutropenic patients who did or did not have infections. However, the median level of soluble Fcgamma receptor III (63 vs. 126 arbitrary units, P = 0.005) was significantly lower among patients who developed infections, whereas the median level of G-CSF (90.9 vs. 53.3 pg/mL, P = 0.04) was significantly higher compared with patients without infections. The area under the ROC curve was 0.58 (P = 0.49) for the absolute neutrophil count, 0.84 (P = 0.007) for soluble Fcgamma receptor III levels, and 0.73 (P = 0.03) for G-CSF levels.
In patients with chronic neutropenia due to rheumatic diseases, low soluble Fcgamma receptor III levels and elevated G-CSF levels are better indicators of the risk of infection than is the neutrophil count.
确定可溶性Fcγ受体III和粒细胞集落刺激因子（G-CSF）的血清水平是否与费尔蒂综合征或系统性红斑狼疮所致中性粒细胞减少症患者的感染风险相关。
采用酶联免疫吸附测定法，检测13例费尔蒂综合征所致中性粒细胞减少症患者、10例系统性红斑狼疮所致中性粒细胞减少症患者以及41例白细胞计数正常的对照者（25例系统性红斑狼疮患者、16例类风湿关节炎患者）的G-CSF和可溶性Fcγ受体III血清水平。我们计算了中性粒细胞绝对计数、可溶性Fcγ受体III水平和G-CSF水平的受试者操作特征（ROC）曲线下面积。
9例中性粒细胞减少症患者（7例费尔蒂综合征患者、2例狼疮患者）在采集血样前后3个月内发生了1次或多次感染。发生感染和未发生感染的中性粒细胞减少症患者的中性粒细胞绝对计数相似。然而，发生感染的患者中可溶性Fcγ受体III的中位数水平（63对126任意单位，P = 0.005）显著较低，而与未发生感染的患者相比，G-CSF的中位数水平（90.9对53.3 pg/mL，P = 0.04）显著较高。中性粒细胞绝对计数的ROC曲线下面积为0.58（P = 0.49），可溶性Fcγ受体III水平的为0.84（P = 0.007），G-CSF水平的为0.73（P = 0.03）。
在风湿性疾病所致慢性中性粒细胞减少症患者中，可溶性Fcγ受体III水平低和G-CSF水平升高比中性粒细胞计数更能准确指示感染风险。
