白细胞介素-6（IL-6）和C反应蛋白（CRP）在癌症化疗期间发热性中性粒细胞减少症儿童和青年中的意义：一项前瞻性研究。

Significance of interleukin-6 (IL-6) and C-reactive protein (CRP) in children and young adults with febrile neutropenia during chemotherapy for cancer: a prospective study.

作者信息

Chaudhary Narendra, Kosaraju Kranthi, Bhat Kamalakshi, Bairy Indira, Borker Anupama

机构信息

Department of Pediatrics, Pediatric Hematology Oncology Unit, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, India.

出版信息

J Pediatr Hematol Oncol. 2012 Nov;34(8):617-23. doi: 10.1097/MPH.0b013e3182677fc6.

DOI:10.1097/MPH.0b013e3182677fc6

PMID:22983415

Abstract

OBJECTIVES

We evaluated the usefulness of interleukin-6 (IL-6) and C-reactive protein (CRP) at the onset of febrile neutropenia and 72 hours later, in identifying risk groups and assessing response to antibiotic therapy.

METHODS

All episodes of febrile neutropenia were divided in 3 study groups-microbiologically documented infection (MDI), clinically documented infection (CDI), and fever of unknown origin (FUO). Three outcome groups were defined as those responding to first-line antibiotics (R1), those responding to second-line antibiotics (R2), and those requiring antifungal therapy (RAF). Median values of IL-6 and CRP were compared between the groups.

RESULTS

There were 57 episodes of febrile neutropenia among 26 patients younger than 25 years during 1 year of study period. On day 1, median IL-6 level was significantly lower in FUO group compared with CDI+MDI groups combined (P < 0.001). Rise in CRP on day 3 was highly significant to differentiate MDI group from other 2 groups (P < 0.001). The CRP also increased significantly on day 3 in RAF (P < 0.001) and R2 (P = 0.002) groups than in R1 group.

CONCLUSIONS

Low level of IL-6 may help differentiate patients with FUO from those with documented infections. A rising CRP is indicative of serious infection.

摘要

目的

我们评估了发热性中性粒细胞减少症发作时及72小时后的白细胞介素-6（IL-6）和C反应蛋白（CRP）在识别风险组和评估抗生素治疗反应方面的作用。

方法

所有发热性中性粒细胞减少症发作分为3个研究组——微生物学确诊感染（MDI）、临床确诊感染（CDI）和不明原因发热（FUO）。定义了3个结果组，即对一线抗生素有反应的组（R1）、对二线抗生素有反应的组（R2）和需要抗真菌治疗的组（RAF）。比较了各组间IL-6和CRP的中位数。

结果

在1年的研究期间，26名25岁以下患者中有57次发热性中性粒细胞减少症发作。第1天，FUO组的IL-6中位数水平显著低于CDI+MDI合并组（P<0.001）。第3天CRP的升高对区分MDI组与其他2组具有高度显著性（P<0.001）。与R1组相比，RAF组（P<0.001）和R2组（P=0.002）第3天的CRP也显著升高。