急性白血病粒细胞缺乏症患者医院感染的临床特征及影响因素研究  

Clinical features for nosocomial infections in patients with agranulocytosis of acute leukemia and analysis of influencing factors

作　　者：魏同 毛夏丽 周琪 李明[2] 张豪[2] 赵龙[2] 席亚明[2] WEI Tong;MAO Xiali;ZHOU Qi;LI Ming;ZHANG Hao;ZHAO Long;XI Yaming(First School of Clinical Medicine,Lanzhou University,Lanzhou,730000,China;Department ofHematology,the First Hospital of Lanzhou University)

机构地区：[1]兰州大学第一临床医学院,兰州730000 [2]兰州大学第一医院血液科

出　　处：《临床血液学杂志》2020年第5期634-639,共6页Journal of Clinical Hematology

摘　　要：目的:研究急性白血病粒细胞缺乏症患者医院感染的临床特征及影响因素,为临床预防及治疗医院感染提供依据。方法:回顾性分析2015-05-2018-05我院住院的594例急性白血病粒细胞缺乏症患者的临床资料,包括性别、年龄、白血病类型、治疗阶段、粒细胞绝对值(ANC)、粒细胞缺乏时间、医院感染、感染部位、平均住院时间、平均感染天数、接受放化疗、是否获得完全缓解、病原学、药物敏感性和耐药性等,采用单因素χ2检验和多因素二分类Logistic回归模型对医院感染相关影响因素进行分析。结果:急性白血病粒细胞缺乏症患者医院感染率为68.86%,常见的部位为上呼吸道(22.29%)、肺(16.07%)和血流(14.66%);急性白血病在初始诱导期及复发难治期感染率较高,分别为79.29%和84.48%。临床共分离出134株病原菌,其中革兰阴性菌99株,占73.88%;革兰阳性菌15株,占11.19%;真菌20株,占14.93%。单因素分析发现,年龄、白血病类型、ANC、粒细胞缺乏时间、是否获得完全缓解、住院时间均与医院感染相关(P<0.05);多因素分析表明,白血病类型、ANC、粒细胞缺乏时间、是否获得完全缓解及住院天数是医院感染的独立影响因素(P<0.05)。结论:急性白血病粒细胞缺乏症患者易发生医院感染,ANC<0.2×109/L,粒细胞缺乏时间大于7 d以及未获得完全缓解的患者感染率更高,应早期采取干预措施,通过药敏情况合理选择抗菌药物,以降低医院感染发生率及病死率。Objective:To explore the clinical features and influencing factors for nosocomial infection in patients with agranulocytosis of acute leukemia,so as to provide evidence for clinical prevention and treatment of nosocomial infections.Method:The clinical data of 594 patients with agranulocytosis of acute leukemia in our hospital from May 2015 to May 2018 were retrospectively analyzed,such as sex,age,leukemia type,treatment stage,absolute neutrophil count(ANC),duration of agranulocytosis,nosocomial infection,sites of infection,the average length of inpatient and average days of infection,drug sensitivity and resistance.Univariate analysis(Chi-square test)and multivariate analysis(binary Logistic regression)were used to analyze the risk factors of nosocomial infection.Result:The nosocomial infection rate of patients with acute leukemia agranulocytosis was 68.86%and the common sites were upper respiratory tract infection(22.29%),lung infection(16.07%)and bloodstream infection(14.66%).Acute leukemia at the initial induction and relapse stages had a higher infection rate,accounting for 79.29%and 84.48%respectively.A total of 134 pathogenic bacteria were isolated clinically,of which 99 were gram-negative bacteria,15 were gram-positive bacteria and 20 were fungi,accounting for 73.88%,11.19%and 14.93%,respectively.Univariate analysis showed that age,leukemia type,ANC,duration of agranulocytosis,complete remission,length of inpatient were all associated with nosocomial infection(P<0.05).Multivariate analysis showed that leukemia type,ANC,duration of agranulocytosis,complete remission,length of inpatient were the independent influencing factors for nosocomial infection(P<0.05).Conclusion:Nosocomial infection for acute leukemia with agranulocytosis continues to be common,especially in patients with acute leukemia who have no complete remission or severe neutropenia,early intervention measures and rational selection of antimicrobial agents based on drug sensitivity should be taken to reduce the incidence of nosocomial infection

关 键 词：急性白血病 粒细胞缺乏症 医院感染 影响因素 

分 类 号：R733.71[医药卫生—肿瘤]