Department of Hematology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Front Cell Infect Microbiol. 2024 Nov 4;14:1476543. doi: 10.3389/fcimb.2024.1476543. eCollection 2024.
Infection is one of the leading causes of death in patients with hematologic cancers. Hematologic cancer patients with compromised immune systems are already susceptible to infections, which come on even more rapidly and are difficult to control after they develop neutrophil deficiencies from high-dose chemotherapy. After patients have developed an infection, the determination of the type of infection becomes a priority for clinicians. In this review, we summarize the biomarkers currently used for the prediction of infections in patients with hematologic cancers; procalcitonin, CD64, cytokines, and CD14 et al. can be used to determine bacterial infections, and (1-3)-β-D-glucan and galactomannan et al. can be used as a determination of fungal infections. We have also focused on the use of metagenomic next-generation sequencing in infections in patients with hematologic cancers, which has excellent clinical value in infection prediction and can detect microorganisms that cannot be detected by conventional testing methods such as blood cultures. Of course, we also focused on infection biomarkers that are not yet used in blood cancer patients but could be used as a future research direction, e.g., human neutrophil lipocalin, serum amyloid A, and heparin-binding protein et al. Finally, clinicians need to combine multiple infection biomarkers, the patient's clinical condition, local susceptibility to the type of infection, and many other factors to make a determination of the type of infection.
感染是血液系统恶性肿瘤患者死亡的主要原因之一。由于免疫系统受损，血液系统恶性肿瘤患者容易发生感染，而且在接受大剂量化疗导致中性粒细胞缺乏后，感染会更快出现且更难控制。患者发生感染后，临床医生首先需要确定感染类型。在这篇综述中，我们总结了目前用于预测血液系统恶性肿瘤患者感染的生物标志物；降钙素原、CD64、细胞因子和 CD14 等可用于确定细菌感染，（1-3）-β-D-葡聚糖和半乳甘露聚糖等可用于确定真菌感染。我们还重点介绍了宏基因组下一代测序在血液系统恶性肿瘤患者感染中的应用，该方法在感染预测方面具有出色的临床价值，可检测到传统检测方法（如血培养）无法检测到的微生物。当然，我们还关注了尚未在血液癌患者中使用但可能作为未来研究方向的感染生物标志物，例如人中性粒细胞明胶酶相关脂质运载蛋白、血清淀粉样蛋白 A 和肝素结合蛋白等。最后，临床医生需要结合多种感染生物标志物、患者的临床状况、感染类型的局部易感性等多种因素来确定感染类型。
