重型再生障碍性贫血患者免疫抑制疗法后血流感染的研究  

Bloodstream infections in severe aplastic anemia patients after immunosuppressive therapy

作　　者：庄顺红[1] 胡慧仙[2] 魏斌[2] 卜黎红[1] 马闪珊[1] ZHUANG Shun-hong;HU Hui-xian;WEI Bin;BU Li-hong;MA Shan-shan(Jinhua Central Hospital in Zhejiang Province, Jinhua , Zhejiang 321000, China)

机构地区：[1]浙江省金华市中心医院检验科,浙江金华321000 [2]浙江省金华市中心医院血液科,浙江金华321000

出　　处：《中华医院感染学杂志》2018年第3期325-327,332,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生一般研究基金资助项目(20160121)

摘　　要：目的探索应用免疫抑制疗法后重型再生障碍性贫血患者并发血流感染的特征、临床疗效、预后效果等研究。方法选取2013年1月-2016年4月于医院接受治疗的58例重型再生障碍性贫血患者为研究对象,观察应用免疫抑制疗法治疗后并发血流感染的重型再生障碍性贫血患者,并分析感染患者病原菌种类及血流感染相关因素。结果 58例患者应用免疫抑制疗法后发生血流感染患者21例,感染率为36.21%,共培养分离病原菌30株,其中革兰阴性菌27株占90.00%,以大肠埃希菌为主;革兰阳性菌3株占10.00%,以粪肠球菌为主。猪-ATG剂量及极重型患者是造成血流感染的影响因素(P<0.05),极重型患者是造成再生障碍性贫血患者血流感染的相关因素(P<0.05)。结论应用免疫抑制疗法与引起重型再生障碍性贫血患者感染有较大关联,且感染率极高;经应用免疫抑制疗法后的重型再生障碍性贫血患者预后效果一般,应制定改良或更有效疗法进行治疗。OBJECTIVE To explore the characteristics, clinical efficacy and prognosis of patients with severe aplas- tic anemia complicated with bloodstream infections after immunosuppressive therapy.METHODS A total of 58 pa- tients with severe aplastic anemia patients from Jan. 2013 to Apr. 2016 in our hospital were selected as the re- search objects. The severe aplastic anemia patients with bloodstream infections after immunosuppressive therapy were observed, and the types of pathogenic bacteria and related factors of bloodstream infections in infected pa- tients were analyzed.RESULTS There were 21 cases of bloodstream infections in 58 patients with immunosuppres- sive therapy, and the infection rate was 36.21%. Totally 30 strains of pathogenic bacteria were cultured, including 27 strains of gram-negative bacteria accounting for 90%, mainly Escherichia coli, and 3 strains of gram-positive bacteria accounting for 10%, mainly Enterococcus faecalis. Swine -ATG dose and extremely severe patients were related factors of bloodstream infections （P〈0.05）, and extremely severe patients were independent risk factors for bloodstream infections in aplastic anemia patients （P〈0.05）. CONCLUSION The application of immunosup- pressive therapy and patients with severe aplastic anemia caused by infections have considerable relevance, and the infection rate is very high. The prognosis of patients with severe aplastic anemia after the application of immuno- suppressive therapy is general, which should develop a more effective therapy method or improvement.

关 键 词：免疫抑制 并发血流感染 再生障碍性贫血 预后疗效 

分 类 号：R556.5[医药卫生—血液循环系统疾病]