免疫抑制治疗后合并血流感染的重型再生障碍性贫血患者临床特征及预后分析  

The clinical feature and outcomes of severe aplastic anemia patients suffered from bacteremia following antithymocyte globulin

作　　者：李星鑫[1] 王敏[1] 邵英起 聂能 施均 黄振东 张静[1] 葛美丽 黄金波 郑以州 

机构地区：[1]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,实验血液学国家重点实验室,天津300020

出　　处：《中华血液学杂志》2016年第9期807-812,共6页Chinese Journal of Hematology

基　　金：基金项目：国家自然科学基金（81470289）

摘　　要：目的分析抗胸腺细胞球蛋白（ATG）治疗后合并血流感染的重型再生障碍性贫血（SAA）患者的临床特征、近期疗效及预后。方法回顾性分析2000年1月至2011年7月行ATG治疗的264例SAA患者的临床特征，并分析合并血流感染患者的细菌学特征及其发生血流感染的危险因素，观察其近期（治疗后3、6个月）疗效，并进行远期预后分析。结果264例患者中有49例（18．6％）ATG治疗后出现血流感染。49例患者中男31例，女18例，中位年龄20（4～62）岁，其中极重型AA（VSAA）38例，SAA11例，治疗后至发生血流感染的中位时间为13（2-233）d。大肠埃希菌、铜绿假单胞菌和肺炎克雷伯杆菌为最常见的菌种，分别占28．4％、20．9％及14．9％。23例（46．9％）患者合并耐药菌血流感染。VSAA患者ATG治疗后血流感染发生率为28．4％（38／134），显著高于SAA患者的8．5％（11／130）（P〈0．001）。VSAA（RR=4．77，95％CI1．97～11．52，P=-0．001）、ATG治疗前1周仍合并感染（RR=4．76，95％C12．05～11．11，P〈0．001）是患者发生血流感染的危险因素。ATG治疗后血流感染患者与无感染者比较，3个月血液学反应率分别为10．6％及35．6％（P〈0．001），6个月血液学反应率分别为17．0％及55．6％（P〈0．001）；5年OS率分别为36．4％（95％CI21-3％～51．5％）及74．5％（95％CI68．4％～80．7％）（P〈0．001）。结论（1）VSAA患者ATG治疗后血流感染发生率高于SAA；②VSAA和ATG治疗前合并感染为发生血流感染的危险因素；③ATG治疗后合并血流感染患者较无感染者近期疗效及远期预后差。Objective To assess the clinical feature and outcomes of severe aplastic anemia （SAA） patients suffered from bacteremia following antithymocyte globulin （ATG）. Methods A total of 264 cases hospitalized in our hospital between Jan 2000 and July 2011 were enrolled into this study. We evaluated the associated pathogens of bacteremia, analyzed the risk factors by Logistic regression and estimated the overall survival （OS） by Kaplan-Meier method for the cohort of patients. Results Bloodstream infections occurred in 49 patients, with a median age of 20 （4-62） years, including 38 cases with very SAA （VSAA） and 11 SAA patients. The median time of bacteremia was 13 （2-233） days following ATG administration. The most common microbiologically were Enterobacteriaceae （28.4%）, Pseudomonas aeruginosa （20.9%） and Klebsiella pneumonia （14.9%）. Almost half （46.9%） of these bacteria were resistant to most or all available antibacterial classes. Univariate and multivariate analyses demonstrated that VSAA, infections during previous week before ATG treatment were risk factors for bacteremia. The 3 and 6 months response rates （10.6% and 17.0% ） were poor in the patients with bloodstream infections, which were significantly lower than those patients without infections （35.6% and 55.6%, respectively, both P〈0.001 ）. The estimated 5-year OS were 36.4% （95%CI 21.3% to 51.5%） and 74.5% （95%CI 68.4% to 80.7%） in the two groups, respectively （P〈0.001）. Conclusions （1）VSAA has higher risk of bacteremia than SAA; （2）Infections during previous week before ATG administration was arisk factor for bacteremia; （3） The outcomes of SAA or VSAA patients suffered from bacteremia following ATG was poor.

关 键 词：抗胸腺细胞球蛋白 贫血 再生障碍性 血流感染 生存期 预后 

分 类 号：R556.5[医药卫生—血液循环系统疾病]