急性白血病患者初次诱导化疗期间感染的临床特点及其与疗效的关系  

Infection in patients with acute leukemia during initial induction chemotherapy and its relation to therapeutic efficacy

作　　者：张楠楠[1] 张睿娟[1] 杨林花[1] 陈阳[1] 许晶[1] 薛凤[1] 尹彬[1] 高峰[1] 

机构地区：[1]山西医科大学第二医院血液科,太原030001

出　　处：《中华全科医师杂志》2017年第12期937-940,共4页Chinese Journal of General Practitioners

摘　　要：目的探讨急性白血病（acute leukemia, AL）患者初次诱导化疗期间感染的临床特点、危险因素及其与疗效的相关性。方法收集2015年1月至2016年2月山西医科大学第二医院血液科病房收治的200例初诊AL患者临床资料，分析患者诱导化疗期间感染的临床特点、危险因素及与疗效的相关性。结果200例AL患者初次诱导化疗期间感染发生率为84.0%（168例），其中，有明确感染部位者占94.6%（159/168），前3位感染部位为肺部（26.1%，93例）、胃肠道（17.1%，61例）、口腔（12.4%，44例）；共检出病原菌213株，其中革兰阴性杆菌占39.0%（83株），革兰阳性球菌占34.3%（73株），真菌占23.5%（50株），病毒占3.3%（7株）；多因素分析感染的危险因素为粒细胞缺乏（OR＝14.370，95%CI：2.576～116.518，P〈0.01）；168例感染患者疾病完全缓解（CR）率＋完全缓解伴血细胞不完全恢复（CRi）率为74.4%（125/168），32例未感染患者CR＋CRi率为87.5%（28/32），两组间差异无统计学意义（χ^2＝2.564, P＝0.109）。结论AL患者初次诱导化疗期间感染发生率高，肺部为最常见感染部位，病原菌以革兰阴性杆菌为多见，且真菌感染率高，粒细胞缺乏增加感染的机会，感染的发生不影响疾病CR/CRi率。ObjectiveTo analyze the infection features, risk factors, and the relationship with the efficacy in patients with acute leukemia during initial induction chemotherapy.MethodsThe clinical data of 200 patients with newly diagnosed acute leukemia from January 2015 to February 2016 in the Second Hospital of Shanxi Medical University were retrospectively analyzed.ResultsThe infection rate of patients with acute leukemia under induction chemotherapy was 84.0% （168/200）. Among 168 patients with infection, 159 cases （94.6%） had known infection sites, the top three infection sites were the lungs, gastrointestinal tract and the oral cavity. Total 213 strains of pathogens were identified, Gram-negative bacilli accounted for 39.0% （n=83）, Gram-positive cocci for 34.3% （n=73）, fungi for 23.5% （n=50） and the virus for 3.3% （n=7）. Multivariate regression analysis showed that agranulocytosis was the independent risk factor for acute leukemia patients during induction chemotherapy（OR=14.370, 95% CI： 2.576-116.518, P〈0.01）. The rate of complete remission （CR） and CR with incomplete hematologic recovery （CRi） in infection group was 74.4% （125/168）, and the rate of CR ＋ CRi in non-infected group was 87.5% （28/32）, and there was no significant difference between the two groups. （χ^2=2.564, P=0.109）.ConclusionDuring the induction therapy for acute leukemia patients, the rate of infection and the rate of fungal infection are high; lung is the most common site, Gram-negative bacteria is more common; agranulocytosis increases the chance of infection; and the infection may not affect the disease remission rate.

关 键 词：白血病 药物疗法 联合 感染 危险因素 

分 类 号：R733.71[医药卫生—肿瘤]