急性髓系白血病诱导缓解期患者下呼吸道感染的危险因素分析  

Risk factors of nosocomial lower respiratory tract infections in patients with acute myeloid leukemia during remission period

作　　者：袁萍[1] 张睿[2] 陈斗佳[1] 石耿辉[1] 彭志元[1] 刘水玉 YUAN Ping ZHANG Rui CHEN Dou-jia SHI Geng-hui PENG Zhi-yuan LIU Shui-yu(Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou 563003, Chin)

机构地区：[1]贵州省遵义医学院附属医院血液内科,贵州遵义563003 [2]贵州省遵义医学院形态学实验室,贵州遵义563003

出　　处：《中华医院感染学杂志》2017年第20期4637-4640,共4页Chinese Journal of Nosocomiology

摘　　要：目的探讨急性髓系白血病(AML)诱导缓解期发生医院下呼吸道感染的特点及危险因素,为临床提供参考。方法回顾性分析医院2012年4月-2016年3月收治的161例AML诱导缓解期患者,观察肺部感染影像学特点,并根据住院时间、抗菌药物应用等临床资料分析出现下呼吸道感染的危险因素。结果 161例患者中共出现肺部感染87例,感染率54.04%,共分离培养病原菌93株,其中革兰阴性菌49株占52.69%,革兰阳性菌24株占25.81%,真菌感染20株占21.51%;细菌性感染表现为肺门影增浓,间质性肺炎,肺段和肺叶实性病变,肺纹理增粗增多,严重者表现为肺气肿、游走性浸润性病灶;真菌感染表现为结节及斑片影、结节影合并空洞影;血小板、血红蛋白、白蛋白是医院下呼吸道感染的相关因素(P<0.05);血小板异常、重度贫血、低蛋白血症是医院下呼吸道感染独立危险因素(P<0.05)。结论 AML诱导缓解期患者医院下呼吸道感染发生率较高,其危险因素有贫血、低蛋白血症、血小板异常,影像学检查能早期发现感染情况。OBJECTIVE To investigate the characteristics and risk factors of nosocomial lower respiratory tract infections in patients with acute myeloid leukemia（AML）during remission period,so as to provide references for clinic.METHODS A total of 161 cases of acute myeloid leukemia patients during remission period from Apr.2012 to Mar.2016 were retrospectively analyzed.The imaging features of pulmonary infections were observed.The risk factors of lower respiratory tract infection were analyzed according to the clinical data of hospital stay and the use of antibiotics,etc.RESULTS Among the 161 patients,87 cases had pulmonary infection,and the infection rate was 54.04%.Totally 93 strains of pathogens were isolated,including 49 strains of gram-negative bacteria,accounting for 52.69%,24 strains of gram-positive bacteria,accounting for 25.81%,and 20 strains of fungal,accounting for 21.51%.The manifestations of bacterial infections were hilar shadow thickening,interstitial pneumonia,pulmonary segmental and lobar solid lesions,lung markings thickening and increasing,and severe cases showed emphysema and migratory infiltrating lesions.The manifestations of fungal infection were characterized by nodular and patchy shadows,nodules,and opacities.Platelet,hemoglobin and albumin were the related factors of nosocomial lower respiratory tract infections（P〈0.05）.Platelet abnormalities,severe anemia and hypoalbuminemia were independent risk factors of nosocomial lower respiratory tract infections（P〈0.05）.CONCLUSION The incidence of nosocomial lower respiratory tract infection is high during remission period in AML patients,the risk factors include anemia,hypoproteinemia and platelet abnormalitie,and imaging examination can detect early infections.

关 键 词：急性髓系白血病 诱导缓解期 下呼吸道感染 影像学特点 危险因素 

分 类 号：R733.71[医药卫生—肿瘤]