血液系统恶性肿瘤患者化疗后粒细胞缺乏感染的危险因素和风险预测模型  

Risk factor analysis and risk prediction model of granulocytopenia infection after chemotherapy in patients with hematological malignancies

作　　者：黄鸿初 黄美容 温丽红 Huang Hongchu;Huang Meirong;Wen Lihong(Laboratory Department of Longhtua Dlistrict People is Hospital in Shenzhen,Shenzhen 518000,China)

机构地区：[1]深圳市龙华区人民医院检验科,深圳市518000

出　　处：《中华实验和临床感染病杂志（电子版）》2024年第5期285-292,共8页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：深圳市龙华区医疗卫生机构区级科研项目(No.2023012);深圳市科技计划项目(No.JCYJ20190808095615389)。

摘　　要：目的分析血液系统恶性肿瘤(HM)患者化疗后粒细胞缺乏期发生感染的危险因素,并构建与验证预测感染发生风险的列线图模型。方法回顾性分析2021年1月至2023年1月深圳市龙华区人民医院收治的120例首发HM化疗后粒细胞缺乏期患者的临床资料,根据患者是否发生感染分为感染组(43例)和对照组(77例)。收集入组患者的一般资料,采用单因素和多因素Logistic回归分析影响HM化疗后粒细胞缺乏期发生感染的独立危险因素,并以此为基础构建预测模型(R软件),绘制受试者工作特征(ROC)曲线和校准曲线图,评估预测模型对HM化疗后粒细胞缺乏期感染发生风险的区分度和准确度。结果120例HM化疗后粒细胞缺乏期患者中,发生感染的患者43例,感染率为35.83%(43/120)。43份感染者标本中共分离出47株病原菌,其中革兰阴性菌33株(70.21%)、革兰阳性菌12株(25.53%)和真菌2株(4.26%)。Logistic多因素分析显示,化疗次数≥3次(OR=2.561、95%CI:2.019~5.031、P<0.001)、皮肤黏膜损害(Ⅰ级:OR=1.547、95%CI:1.215~1.978、P<0.001;Ⅱ级:OR=2.649、95%CI:1.134~4.547、P<0.001;Ⅲ级:OR=3.423、95%CI:1.753~6.686、P<0.001)、粒细胞缺乏期mIPS评分≥13分(OR=4.447、95%CI:1.830~8.842、P<0.001)、粒细胞缺乏≥7 d(OR=5.571、95%CI:1.842~9.421、P<0.001)、住院≥14 d(OR=2.213、95%CI:1.264~4.431、P<0.001)均为HM化疗后粒细胞缺乏期患者发生感染的危险因素。列线图模型预测HM化疗后粒细胞缺乏期患者发生感染的曲线下面积为0.846(95%CI:0.809~0.884),灵敏度和特异度分别为87.15%和89.67%,预测感染发生的校准曲线斜率接近1,且拟合优度检验显示该列线图模型预测HM化疗后粒细胞缺乏期患者发生感染风险的概率与实际概率差异无统计学意义(χ^(2)=0.169、P=0.643)。结论HM化疗后粒细胞缺乏期患者发生感染风险较高,化疗次数≥3次、有皮肤黏膜损害、粒细胞缺乏期mIPS评分≥13分、粒细胞缺�Objective To investigate the risk factors for infection in patients with hematological malignancies(HM)undergoing chemotherapy and neutropenia,and to construct and validate a column chart model for predicting the risk of infection.Methods A retrospective analysis was conducted on the clinical data of 120 patients admitted to Longhua District People’s Hospital in Shenzhen from January 2021 to January 2023 who underwent initial HM chemotherapy and had a neutropenia phase,all patients were divided into infected group(43 cases)and control group(77 cases)based on whether infection occurred.Independent risk factors for infection during the neutropenia phase after HM chemotherapy were analyzed through univariate and multivariate Logistic regression analysis,and a predictive model(R software)was constructed.The discrimination and accuracy of the predictive model on the risk of infection during the neutropenia phase after HM chemotherapy were evaluated by receiver operating characteristic(ROC)curves and calibration curves.Among the 120 patients with neutropenia after HM chemotherapy,43 patients developed infection,with an infection rate of 35.83%(43/120).Total of 47 strains of pathogenic bacteria were detected in 43 specimens of infected patients,including 33 strains(70.21%)of Gram negative bacteria,12 strains(25.53%)of Gram positive bacteria,and 2 strains(4.26%)of fungi.Multivariate analysis showed that the frequency of chemotherapy≥3 times(OR=2.561,95%CI:0.019-5.031,P<0.001),cutaneous mucosal lesion(GradeⅠ:OR=1.547,95%CI:1.215-1.978,P<0.001;GradeⅡ:OR=2.649,95%CI:1.134-4.547,P<0.001;GradeⅢ:OR=3.423,95%CI:1.753-6.686,P<0.001),and the improved infection likelihood score(mIPS)in the neutropenia phase≥13 points(OR=4.447,95%CI:1.830-8.842,P<0.001)were all risk factors for infection of patients with HM.Patients with HM chemotherapy who have a neutropenia period≥7 days(OR=5.571,95%CI:1.842-9.421,P<0.001)and a hospital stay≥14 days(OR=2.213,95%CI:1.264-4.431,P<0.001)were more likely to develop infections during t

关 键 词：血液系统恶性肿瘤 化疗 粒细胞缺乏期 感染 危险因素 风险预测模型 

分 类 号：R730.53[医药卫生—肿瘤]