血液重症监护病房伴脓毒症血液病患者的临床特征及预后分析  

Clinical characteristics and prognostic evaluation of patients with hematological disease and sepsis in the Hematological intensive care unit

作　　者：李海涛[1] 卢冬雪 李丹丹[1] 张东阳 付金月 张倩[1] 范圣瑾[1] Li Haitao;Lu Dongxue;Li Dandan;Zhang Dongyang;Fu Jinyue;Zhang Qian;Fan Shengjin(The First Affiliated Hospital of Harbin Medical University,Heilongjiang Institute of Hematology&Oncology,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院,黑龙江血液肿瘤研究所,血液肿瘤重症监护病房,哈尔滨150001

出　　处：《中华血液学杂志》2025年第1期58-63,共6页Chinese Journal of Hematology

基　　金：国家自然科学基金(81430088)。

摘　　要：目的分析血液重症监护病房(HCU)伴中性粒细胞缺乏(粒缺)脓毒症血液病患者的临床特征和预后。方法对2017年10月至2024年10月期间哈尔滨医科大学附属第一医院HCU收治的伴脓毒症血液病患者进行回顾性分析。结果共245例伴脓毒症血液病患者纳入研究,其中88例伴中性粒细胞缺乏(粒缺组),157例不伴中性粒细胞缺乏(非粒缺组)。急性白血病在粒缺组更为常见(55.68%,49/88)。在转入HCU时,与非粒缺组相比,粒缺组生命体征不稳定,全血细胞计数较低,炎性指标和SOFA评分较高,脓毒性休克较多见[53.40%(47/88)对36.94%(58/157),P<0.05],肌酐(120.00µmol/L对77.10µmol/L,P<0.01)、总胆红素(24.70µmol/L对17.90µmol/L,P<0.01)和脑钠肽水平(567.90 ng/L对134.50 ng/L,P<0.01)较高。在HCU治疗期间,与非粒缺组相比,粒缺组死亡率较高[46.59%(41/88)对32.48%(51/157),P<0.05],脓毒性休克是主要死亡原因(70.73%,29/41);粒缺组革兰阴性菌[55.68%(49/88)对36.30%(57/157),P<0.01]和真菌[14.77%(13/88)对6.36%(10/157),P<0.05]较多见,肺部感染较少(P<0.01)。Kaplan-Meier生存曲线显示,粒缺组确诊脓毒症后28天的总生存率显著低于非粒缺组[(53.9±5.3)%对(67.7±3.7)%,P=0.031]。结论与非粒缺脓毒症患者相比,HCU中伴粒缺脓毒症血液病患者病情较重,更容易发生器官功能障碍和脓毒性休克,死亡率更高。ObjectiveTo identify the clinical characteristics and prognosis of patients with hematological disease and neutropenic sepsis in the hematological intensive care unit(HCU).MethodsA retrospective analysis was conducted on patients with hematological disease and sepsis who admitted to HCU,the First Affiliated Hospital of Harbin Medical University from October 2017 to October 2024,to examine the primary therapeutic options,prognosis,cause of death,and infectious features of sepsis.ResultsA total of 245 septic patients were included in the study,comprising 88 cases in the neutropenic sepsis group(neutropenic group)and 157 cases in the non-neutropenic sepsis group(non-neutropenic group).Acute leukemia was more prevalent in the neutropenic group[55.68%(49/88)].At the time of admission to the HCU,the neutropenic group exhibited unstable vital signs,lower blood cell counts,higher inflammatory markers,elevated Sequential Organ Failure Assessment(SOFA)scores,increased creatinine levels(120.00µmol/L vs 77.10µmol/L,P<0.01),higher total bilirubin levels(24.70µmol/L vs 17.90µmol/L,P<0.01),and significantly elevated B-type natriuretic peptide levels(567.90 ng/L vs 134.50 ng/L,P<0.01)compared with the non-neutropenic group.Furthermore,septic shock was more common in the neutropenic group[53.40%(47/88)vs 36.94%(58/157),P<0.05].The mortality rate was also higher in the neutropenic group[46.59%(41/88)]compared with the non-neutropenic group[32.48%(51/157)](P<0.05),with septic shock accounting for the majority of deaths[70.73%(29/41)].Infections caused by gram-negative bacteria[55.68%(49/88)vs 36.30%(57/157),P<0.01]and fungi[14.77%(13/88)vs 6.36%(10/157),P<0.05]were more common in the neutropenic group.However,lung infections were significantly less frequent in the neutropenic group(P<0.01).Kaplan-Meier survival analysis revealed a substantially worse 28-day overall survival rate for the neutropenic group compared with the non-neutropenic group(P<0.05).ConclusionPatients with hematological diseases and neutropenic sepsis present

关 键 词：粒细胞缺乏 脓毒症 血液病 

分 类 号：R459.7[医药卫生—急诊医学]