鼻NK/T细胞淋巴瘤合并细菌感染的诊治经验与教训  

Experience and Lessons in Diagnosis and Treatment of Nasal NK/T Cell Lymphoma with Bacterial Infection

作　　者：刘蕾[1] 张娜[2] 翟冠婷 王英[1] 赵玉林[1] LIU Lei;ZHANG Na;ZHAI Guanting;WANG Ying;ZHAO Yulin(Department of Rhinology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Infection Control Department,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院鼻科,河南郑州450052 [2]郑州大学第一附属医院感染管理科,河南郑州450052

出　　处：《河南医学研究》2023年第20期3709-3712,共4页Henan Medical Research

摘　　要：目的 探讨鼻NK/T细胞淋巴瘤合并细菌感染的类型和特点。方法 回顾性分析2018年4月至2022年12月在郑州大学第一附属医院确诊且在入院时伴有发热的鼻NK/T细胞淋巴瘤患者的临床资料和细菌培养结果。结果 41例入院时伴有发热的鼻NK/T细胞淋巴瘤患者进行了细菌培养,其中有10例患者细菌培养结果阳性,培养菌株均为葡萄球菌,其中3例为人葡萄球菌人亚种,7例为金黄色葡萄球菌。10例患者均对林可霉素类及大环内酯类抗生素交叉耐药,其中9例患者除耐甲氧西林外还存在其他种类抗生素耐药。2例患者因恶病质、感染性休克死亡,剩余8例患者在更换抗生素或同时加放化疗后发热得到控制。结论 在确诊鼻NK/T细胞淋巴瘤前伴有反复发热的患者合并的感染细菌以葡萄球菌为主,且大多为多重耐药菌,普遍对常用的青霉素类、头孢类及林可霉素类、大环内酯类抗生素耐药,应常规对患者行细菌培养,根据药敏结果应用抗生素,并尽早确诊,给予抗肿瘤治疗。Objective To investigate the types and features of nasal NK/T cell lymphoma with bacterial infection.Methods The clinical data and bacterial culture results of nasal NK/T cell lymphoma patients with fever when admitted to the First Affiliated Hospital of Zhengzhou University from April 2018 to December 2022 were retrospectively analyzed.Results Bacterial culture was performed on 41 patients with nasal NK/T cell lymphoma with fever at admission.Among them,10 patients had positive bacterial culture results,and the cultured strains were all Staphylococcus,among which 3 cases were Staphylococcus hominis subspecies and 7 cases were Staphylococcus aureus.All the 10 patients were cross-resistant to lincomycin and macrolide antibiotics,and 9 of them were resistant to other antibiotics besides methicillin.Two patients died due to cachexia and septic shock,and the remaining eight patients had fever under control after changing antibiotics or adding chemoradiotherapy.Conclusion Staphylococcus is the main infectious bacteria in patients with recurrent fever before diagnosis of nasal NK/T cell lymphoma,and most of them are multi-drug resistant bacteria,which were generally resistant to commonly used penicillins,cephalosporins,lincomycin antibiotics and macrolide antibiotics.Therefore,such patients should be routinely examined for bacterial culture,antibiotics should be applied according to the drug sensitivity results,and nasal NK/T cell lymphoma should be diagnosed and given anti-tumor therapy as soon as possible.

关 键 词：鼻NK/T细胞淋巴瘤 细菌感染 耐药菌 

分 类 号：R446.5[医药卫生—诊断学]