成人急性白血病患者住院化疗感染的临床特征及影响因素研究  

Clinical features and risk factors for infections in adult acute leukemia after chemotherapy

作　　者：骆宜茗[1] 刘庭波[2] 谢泗停[1] 王思力[1] 方志鸿[1] 苏蕊[1] 李志峰[1] 黄耘[1] 林志娟[1] 韩明哲[3] 

机构地区：[1]厦门大学附属第一医院、福建医科大学教学医院,361003 [2]福建医科大学附属协和医院 [3]中国医学科学院、北京协和医学院血液学研究所、血液病医院

出　　处：《中华血液学杂志》2015年第12期1020-1024,共5页Chinese Journal of Hematology

摘　　要：目的研究成人急性白血病（AL）患者住院化疗感染的临床特征，探讨感染的影响因素。方法回顾性分析2010年7月至2014年12月厦门大学附属第一医院住院化疗的191例成人AL患者临床资料，研究感染的临床特征及影响因素。结果191例AL患者累计完成化疗728个疗程，其中385个疗程出现感染，占52．9％。明确感染部位者374例次，常见的感染部位为下呼吸道（36．3％，153／374）、血流感染（17．1％，64／374）、口腔（13．6％，51／374）和肛周（13．4％，50／374）。共检出164株病原菌，革兰阴性菌占59．1％，革兰阳性菌占32．9％。Logistic多元回归分析显示，未获得完全缓解（OR=0．142，P〈0．001）、中性粒细胞缺乏时间97d（OR=12．764，P〈0．001）、住普通病房（OR=I．821，P〈0．001）、住院时间〉10d（OR=0．720，P=-0．039）是AL患者住院化疗感染的独立危险因素。结论成人AL患者住院化疗易发生感染，未获得完全缓解以及化疗后粒细胞缺乏时间97d的患者感染发生率更高；缩短住院时间、住层流病房可减少感染的发生。Objective To observe the clinical characteristics of infections in adult acute leukemia （AL） patients during chemotherapy in hospital, and identify the risk factors for infections. Methods A retrospective study of patients with AL who underwent chemotherapy between July 2010 and Dec 2014 in the First Affiliated Hospital of Xiamen University was conducted. Clinical features and risk factors for infections were analyzed. Results 191 patients with AL received a total of 728 courses of chemotherapies. During these admissions, 385 （52.9%） infections episodes occurred. The common infections sites were lower respiratory tract infection （36.3%, 153/374）, bloodstream infection （17.1%, 64/374）, oral infection （13.6%, 51/374）, and perianal infection （13.4%, 50/374）. 164 strains of pathogenic bacteria were detected. Gram-negative bacteria were recorded in 59.1% of documented pathogens, and Gram-positive bacteria were responsible for 32.9% of infections. Multivariate unconditioned logistic analysis of factors identified consistent independent risk factors for no completely remission （OR=0.142, P〈 0.001 ）, duration of neutropenia longer than 7 days （OR= 12.764, P〈0.001 ）, general wards （OR= 1.821, P〈 0.001 ）, and hospitalization interval longer than 10 days （0R=0.720, P=0.039）. Conclusion Infections after chemotherapy for AL continues to be common. AL patients with induction chemotherapy or severe neutropenia faced an increased risk of infections by multivariate analysis. And patients with short-term stay or laminar flow wards seem to be less susceptible to infections.

关 键 词：白血病 感染 危险因素 

分 类 号：R733.71[医药卫生—肿瘤]