急性白血病移植后医院感染的特点  

Clinical characteristics of nosocomial infection in acute leukemia patients after transplantation

作　　者：陈文婷[1] 姚红霞[1] 吴从明[1] 符祥俊[1] 黄昭前[1] CHEN Wen-ting;YAO Hong-xia;WU Cong-ming;FU Xiang-jun;HUANG Zhao-qian(Hainan Provincial People's Hospital, Haikou , Hainan 570311, China)

机构地区：[1]海南省人民医院血液内科

出　　处：《中华医院感染学杂志》2019年第13期1971-1974,共4页Chinese Journal of Nosocomiology

基　　金：海南省自然科学基金资助项目(814313)

摘　　要：目的研究急性白血病移植患者医院感染的临床特点及CD3^+、CD4^+ T细胞计数对预后的影响。方法选取2014年9月-2017年8月在医院行急性白血病移植的患者92例为观察组,另选取同期在医院进行健康体检的73名健康体检者为对照组。分析急性白血病移植患者医院感染部位和住院时间,病原学特点,两组研究对象CD3^+、CD3^+CD4^+、CD3^+CD8^+T细胞绝对值。结果 92例急性白血病移植患者共发生医院感染113例次,其中最多的是上呼吸道感染为35.40%,其次是下呼吸道感染为26.55%,最少的泌尿道感染为7.08%,感染部位不同住院时间不同,其中上呼吸道感染的住院时间最短,住院时间最长的是血液感染。在92例急性白血病移植患者中共检出病原菌107株,其中真菌12株(11.21%),革兰阴性菌65株(60.75%),革兰阳性菌30株(28.04%)。观察组的CD3^+、CD3^+CD4^+T细胞绝对值、CD3^+CD4^+/CD3^+CD8^+比值显著低于对照组(P<0.05)。结论急性白血病移植患者医院感染率较高,感染部位以上呼吸道感染为主,病原菌以革兰阴性菌为主,通过检测T淋巴细胞亚群能判断白血病患者机体免疫状况和疾病严重程度。OBJECTIVE To study the clinical characteristics of nosocomial infection in the acute leukemia patients undergoing transplantation and observe the effect of CD3^+, CD4^+ T cell counts on prognosis. METHODS Totally 92 acute leukemia patients who underwent the transplantation in the hospital from Sep 2014 to Aug 2017 were assigned as the observation group, meanwhile, 73 healthy people who received physical examination were set as the control group. The nosocomial infection sites, length of hospital stay and etiological characteristics of the patients were observed, and the absolute values of CD3^+, CD3^+CD4^+ and CD3^+CD8^+T cell were observed and compared between the two groups of study objects. RESULTS Among the 92 patients with acute leukemia undergoing transplantation, 113 case-times of patients had nosocomial infection, 35.40% of whom had upper respiratory tract infection, 26.55% had lower respiratory tract infection, and 7.08% had urinary tract infection. The patients with different sites of infection varied in the length of hospital stay, the length of hospital stay of the patients with upper respiratory tract infection was the shortest, while the length of hospital stay of the patients with blood infection was the longest. A total of 107 strains of pathogens were isolated from the 92 patients with acute leukemia, 12(11.21%) of which were fungi, 65(60.75%) were gram-negative bacteria, and 30(28.04%) were gram-positive bacteria. The absolute values of CD3^+ and CD3^+CD4^+T cell and CD3^+CD4^+/CD3^+CD8^+ ratio were significantly lower in the observation group than in the control group( P<0.05). CONCLUSION The incidence of nosocomial infection is high among the acute leukemia patients undergoing transplantation, the lower respiratory tract is the major infection site, the gram-negative bacteria are dominant among the pathogen, and the levels of T lymphocyte subsets may predict the immune state and severity of disease of the patients with leukemia.

关 键 词：急性白血病 医院感染 临床特点 T细胞计数 

分 类 号：R733.71[医药卫生—肿瘤]