摘要
目的了解恶性血液病患者袭性真菌感染的发生率及危险因素,为重症患者的真菌感染防治提供依据。方法回顾性调查2013年1月至12月期间的495例恶性血液病住院患者资料,用卡方检验及多因素Logistic回归分析等统计方法分析侵袭性真菌感染的危险因素。结果 16.4%(81/495)的患者发生侵袭性真菌感染,其中急性白血病、慢性白血病、骨髓增生异常综合征、淋巴瘤和多发性骨髓瘤患者的真菌感染发生率分别为31.1%(66/212)、0.0%(0/19)、31.2%(5/16)、4.8%(10/207)和0.0%(0/41)。外周血白细胞计数低值≤1.0E+9/L、粒细胞缺少时间≥8天、使用糖皮质激素及抗生素使用种类≥3种是恶性血液病患者侵袭性真菌感染的独立危险因素,预防性使用抗真菌药物是独立保护因素(OR值分别为15.830、41.667、3.745、8.264及39.085,P值分别为0.000、0.011、0.035、0.007及0.000)。结论合理使用抗生素和糖皮质激素、在粒细胞缺少时间较长病例中及时使用集落刺激因子、抗真菌药或重建微生态是防治恶性血液病患者真菌感染的必要措施。
Objective To investigate the incidence and risk factors of invasive fungal infections in patients with hematopoietic malignancies, and provide advices for prevention and treatment of invasive fungal infections. Methods A retrospective cohort study was performed to identify the risk factors of invasive fungal infections in 495 patients with hematopoietic malignancies, who were admitted to our hospital from January to December 2013, by chi square test and multivariate logistic regression analysis. Results 16. 4% （81/495） of the patients were infec- ted by fungi. The incidences of invasive fungal infections in patients with acute leukemia, chronic leukemia, myel- odysplastie syndrome, lymphoma and muhiple myeloma were 31.1% （66/212） , 0.0% （0/19） , 31.2% （5/16）, 4. 8% （10/207） and 0. 0% （0/41） respectively. The risk factors for invasive fungal infections in patients with hematopoietic malignancies were as follows： 1. WBC count in peripheral blood was lower than or equal to 1.0E ＋ 9/L; 2. The patient suffered from neutropenia longer than 7 days ; 3. The patient was treated with glucocor- ticoids; 4. The patient was treated with more than three antibiotics. The protective factor was prophylactic use of antifungal drugs. The OR values of above factors were 15. 830, 41. 667, 3. 745, 8. 264 and 39. 085 respectively; the P values were 0. 000, 0. 011, 0. 035, 0. 007 and 0. 000 respectively. Conclusion The key measures to re- duce incidence of invasive fungal infections in patients with hematopoietic malignancies were using antibiotics and glucocorticoid appropriately, using antifungal drugs and colony stimulating factors in time, and rebuilding normal microbial ecology.
出处
《中国微生态学杂志》
CAS
CSCD
2015年第4期417-420,共4页
Chinese Journal of Microecology
基金
国家重点基础研究发展计划(973计划)项目(2013CB531400和2013CB531605)
国家自然科学基金项目(81101283)
关键词
恶性血液病
侵袭性
真菌感染
危险因素
Hematopoietic malignancy
Invasive
Fungal infection
Risk factor
