多发性骨髓瘤患者肺部感染的临床特点及相关因素分析  

Clinical characteristics and related factors of pulmonary infection in patients with multiple myeloma

作　　者：王双玲[1] 刘峰[1] 陈江声[1] 陆培文[1] 

机构地区：[1]汕头大学医学院第二附属医院血液肿瘤科,广东汕头515000

出　　处：《中国感染与化疗杂志》2017年第3期253-255,共3页Chinese Journal of Infection and Chemotherapy

摘　　要：目的分析多发性骨髓瘤患者发生肺部感染的临床特点,以期为早期预防和临床诊疗提供理论依据。方法回顾性分析2012年1月-2015年4月收治住院的70例多发性骨髓瘤患者的相关资料,对患者的肺部感染临床表现及影像学特点、病原菌分布、感染相关因素进行分析。结果多发性骨髓瘤患者发生肺部感染时外周血白细胞计数和中性粒细胞比例可以表现为正常,红细胞沉降率明显增高,影像学提示以双肺感染较常见,常见病原菌是以铜绿假单胞菌为主的革兰阴性菌。发生肺部感染的易感因素主要是:粒细胞缺乏、Ⅲ期多发性骨髓瘤、合并症。结论多发性骨髓瘤患者发生肺部感染的临床症状多样;其易感因素主要是机体免疫力低下;常见病原菌是革兰阴性菌。在病原菌未检出前,经验性使用β内酰胺类-酶抑制剂复合制剂或喹诺酮类药物治疗可有效控制感染进展。Objective To analyze the clinical characteristics of pulmonary infection in patients with multiple myeloma for improving early prevention, diagnosis and treatment. Methods A retrospective analysis was conducted for 70 patients with multiple myeloma admitted to our hospital from January 2012 to April 2015. The clinical data of pulmonary infection were reviewed and analyzed in terms of radiological findings, pathogen distribution, and related risk factors. Results The peripheral white blood cell count and neutrophil percentage could be normal in pulmonary infection of patients with multiple myeloma. However, erythrocyte sedimentation rate increased significantly. Radiological study revealed that infection of bilateral lungs was common. The most frequently identified pathogens were gram negative bacteria, especially Pseudomonas aeruginosa. The main predisposing factors of pulmonary infection were agranulocytosis, stage III multiple myeloma, and complications. Conclusions The clinical symptoms of pulmonary infection are diverse in patients with multiple myeloma. Poor immunity is the primary predisposing factor. The common pathogens are gram-negative bacteria. Beta-lactam/beta-lactamase inhibitor combinations or fluoroquinolones are effective empiric treatment for controlling the progression of pulmonary infection.

关 键 词：多发性骨髓瘤 肺部感染 粒细胞缺乏 

分 类 号：R563.1[医药卫生—呼吸系统] R733.3[医药卫生—内科学]