多发性骨髓瘤患者继发败血症的危险因素分析  

Risk factors for sepsis in multiple myeloma patients

作　　者：马泳泳[1] 周淑娟[1] 葛杭萍[1] 沈志坚[1] 钱红兰[1] 蔡芳芳[1] 俞康[1] 

机构地区：[1]温州医科大学附属第一医院血液科,浙江温州325000

出　　处：《中华医院感染学杂志》2014年第19期4799-4801,共3页Chinese Journal of Nosocomiology

基　　金：浙江省卫生厅基金资助项目(2014KYA132);温州市科技计划基金项目(Y20100106;Y20140072)

摘　　要：目的探讨多发性骨髓瘤(MM)患者化疗后败血症的危险因素,以期临床早期预防。方法选择1997年1月-2012年10月血液科住院的MM患者,其中败血症患者42例为研究组,另从同期住院无败血症的MM患者中随机抽取57例作为对照组,对继发败血症的危险因素进行分析,采用法国生物梅里埃公司VITEK-AMS60全自动分析仪进行菌种鉴定,采用GNS-120药敏卡进行最低抑菌浓度(MIC)测定,采用SPSS16.0软件对数据进行处理。结果败血症患者发热42例、畏寒31例、寒颤23例,分布率分别为100.00%、73.81%、54.76%;单因素分析显示,血清白蛋白<30g/L、肾功能不全、骨髓瘤未缓解、血清β-微球蛋白≥3.5mg/L与MM患者败血症发病显著相关(P<0.001);多因素logistic回归分析显示,血清白蛋白<30g/L(OR=3.621)、肾功能不全(OR=3.075)与多发性骨髓瘤患者败血症发病呈正相关,差异有统计学意义(P<0.05);而骨髓瘤达缓解状态(CR/PR)(OR=0.074)与MM患者败血症发病呈负相关(P<0.05);败血症患者共分离出42株病原菌,革兰阳性菌12株,占28.57%,革兰阴性菌25株占59.53%,真菌5株占11.90%。结论血清白蛋白<30g/L、肾功能不全是MM患者发生败血症的重要因素,而骨髓瘤达缓解状态是MM患者发生败血症的保护因素,医师应关注MM患者发生败血症的危险因素,早期给予积极治疗。OBJECTIVE To investigate risk factors for sepsis in multiple myeloma patients after chemotherapy.METHODS A retrospective case-control study was performed.Sample for this study was multiple myeloma patients received in the hematology department from Jan.1997 to Oct.2012,and divided into two groups：study group（42sepsis patients）and control group（57random-sampled multiple myeloma patients without sepsis）.The risk factors for secondary sepsis were analyzed by univariate analysis and then by multivariate logistic regression.Bacteria strains were identified and minimum inhibitory concentration was tested.Data collected were processed by SPASS16.0.RESULTS Univariate analysis showed that sepsis was significantly associated with serum albumin（〈30g/L）,renal dysfunction,unremitted myeloma,serumβ-microglobulin≥3.5mg/L（P〈0.001）.Multivariate logistic regression analysis showed that sepsis was positively associated（P〈0.05）with serum albumin〈30g/L（OR =3.621）,renal dysfunction（OR =3.075）,and was negatively related with unremitted myeloma（OR=0.074）.Remitted myeloma（CR/PR）（OR=0.074）was negatively related with secondary sepsis among multiple myeloma patients（P〈0.05）.Totally,42 strains of pathogens were isolated：12strains of gram-positive bacteria（28.57%）,25 strains of gram-negative bacteria（59.53%）and five strains of fungi（11.90%）.CONCLUSIONS Serum albumin〈30g/L,renal dysfunction are important risk factors for sepsis,while remitted myeloma is protective.Patients with an adverse disease profile should be observed closely and may be the target group for early and aggressive intervention.

关 键 词：多发性骨髓瘤 败血症 危险因素 

分 类 号：R733.3[医药卫生—肿瘤]