原发免疫性血小板减少症患者继发感染的相关因素研究  

Infection factors of secondary infection in patients with primary immune thrombocytopenia

作　　者：金玲娟[1] 朱倩[1] 陈海飞[1] 吴天勤[1] 沈红石[1] 秦龙梅 李征洋[1] 任永亚[1] 钱琤[1] 余自强[2] 

机构地区：[1]中国人民解放军第一〇〇医院血液科,江苏苏州215007 [2]江苏苏州大学附属第一医院江苏省血液研究所,215007

出　　处：《国际输血及血液学杂志》2017年第2期125-132,共8页International Journal of Blood Transfusion and Hematology

基　　金：军队医药卫生科研课题重点项目（15ZD009、14MS026）

摘　　要：目的探讨原发免疫性血小板减少症（ITP）患者确诊后1年内继发感染的影响因素。方法选择2007年7月至2015年，7月于解放军第一〇〇医院血液科就诊的522例ITP患者中，诊断后1年内继发感染的47例患者为研究对象，将其纳入感染组（n=47）；采用随机数字表法按照1年内继发与未继发感染者例数比为1：1．4的比例，抽取诊断后1年内未继发感染的67例ITP患者纳入非感染组（n=67）。将2组患者临床特征、实验室检查结果、治疗方法、疗效进行单因素分析，根据单因素分析结果及临床经验，将相关临床指标纳入多因素非条件Logistic回归分析，并采用受试者工作特征曲线（ROC）分析影响因素对ITP患者1年内继发感染的预测价值。结果①2组ITP患者年龄、合并症发生率比较，差异有统计学意义（t=4．559、X^2=11．400；P〈0．001）。②感染组ITP患者的淋巴细胞绝对计数（ALC）为（1．5±0．2）×10^9／L，低于非感染组的（1．6±0．1）×10^9／L，而感染组C反应蛋白（CRP）和乳酸脱氢酶（LDH）水平分别为（19．6±5．1）mg／L和（286．6±15．7）U／L，均高于非感染组的（4．0±2．1）mg／L和（232．3±11．8）U／L，2组分别比较，差异均有统计意义（t=-0．369、2．792和2．828，P〈O．05）。③感染组接受脾切除、利妥昔单抗治疗患者分别为7例和4例，高于非感染组的1例和0例，2组比较，差异有统计学意义（X^2=7．603、5．909，P〈O．05）。④2组ITP患者疗效比较，差异有统计学意义（X^2=8．257，P=0．016）。⑤多因素非条件Logistic回归分析结果显示，年龄（OR=1．074，95％CI：1．025～1．125），LDH水平（OR=1．021，95％CI：1．006～1．035），脾切除（OR=12．423，95％CI：1．252～123．245）是ITP患者继发感染的独立危险因素；ALC（OR=0．051，95％CI：0．011～O．243）是ITP患者继发感染的独立保护因素。�Objective Explore secondary infection risk factors of patients with primary immune thrombocytopenia （ITP） within 1 year after diagnosed. Methods From July 2007 to July 2015, a total 47 ITP patients with secondary infection within 1 year after diagnosis were included in the study as infection group （n=14）, who were chosen from 522 ITP patients in the 100th Hospital of the Chinese People＇s Liberation Army. According to the proportion of 1 ： 1.4, 67 uninfected ITP patients were chosen as non-infection group （n = 67） randomly. The clinical features, laboratory findings, treatment methods and curative effects were statistically compared by univariate analysis between two groups, and the clinical indicators which had been resulted by univariate analysis and clinical experiences were included in the multivariate unconditional Logistic regression analysis. The receiver operating characteristic curve（ROC） was taken to analyse the influencing factors on the predictive value of ITP patients with secondary infection. Results ①There were statistically significant differences between two groups in age and complications （t= 4. 559, X^2 =11. 400; P〈0. 001）. ②The absolute lymphocyte count （ALC） in infection group was （1.5±0.2） × 10^9/L,which lower than that of non-infection group （1.6±0.1）×10^9/L, and the levels of C-reactive protein （CRP） and lactate dehydrogenase （LDH） in infection group were （19.6±5.1） mg/L and （286.6±15.7） U/L, respectively , which were higher than those of non-infection group, and the differences were significant （t=-0.369, 2. 792,2. 828; P〈0.05）. ③The number of patients who accepted treatment of splenectomy and rituximab were 7 cases and 4 cases, respectively ,which higher than those of non-infection group（1 cases and 0） , and the difference was statistically significant （X^2= 7. 603, 5. 909 ; P〈0. 05）. ④There was significant difference in clinical effect between two groups （X^2= 8. 257, P = 0. 016）. ⑤Multivariate Log

关 键 词：血小板减少 感染 发病年龄 淋巴细胞计数 乳酸脱氢酶类 

分 类 号：R558.2[医药卫生—血液循环系统疾病]