目的了解中国血液病患者中性粒细胞缺乏(粒缺)伴发热的发生率、临床和微生物学特征及危险因素。方法前瞻性研究2014年10月20日至2015年3月20日来自全国11家血液病中心发生粒缺伴发热的连续血液病患者发热情况及危险性因素。结果1 139...目的了解中国血液病患者中性粒细胞缺乏(粒缺)伴发热的发生率、临床和微生物学特征及危险因素。方法前瞻性研究2014年10月20日至2015年3月20日来自全国11家血液病中心发生粒缺伴发热的连续血液病患者发热情况及危险性因素。结果1 139例患者共发生784例次粒缺伴发热,粒缺持续21 d时发热的累积发生率为81.9%。多因素分析显示中心静脉置管(P〈0.001,HR= 3.407,95% CI 2.276-4.496 )、胃肠道黏膜炎(P〈0.001,HR=10.548, 95% CI 3.245-28.576)、既往90 d内暴露于广谱抗生素(P〈0.001,HR=3.582,95% CI 2.387-5.770)和粒缺持续时间〉7 d (P〈0.001,HR= 4.194,95% CI 2.572-5.618)是粒缺伴发热的危险因素。无任何危险因素、具备1项、2项、3-4项危险因素患者发热的累计发生率依次增加(35.4%、69.2%、86.1%及95.6%,P〈0.001)。784例次粒缺伴发热中,不明原因发热253例次(32.3%),临床证实的感染429例次(54.7%),微生物学证实的感染102例次(13.0%)。最常见的感染部位依次为肺(388例次,49.5%)、上呼吸道(159例次,16.0%)、肛周组织(77例次,9.8%)、血流(60例次,7.7%)。最常见的病原菌为革兰阴性菌(44.54%),其次为革兰阳性菌(37.99%)和真菌(17.47%)。发热与未发热患者相比,两组之间总体病死率差异无统计学意义(9.2%对4.8%,P=0.099)。多因素分析显示年龄〉40岁(P=0.047 ,HR=5.000 ,95% CI 0.853-28.013 )、血流动力学不稳(P=0.001,HR=13.185, 95% CI 2.983-54.915)、既往耐药菌的定植或感染(P=0.005 ,HR=28.734, 95% CI 2.921-313.744)、血流感染(P=0.038 ,HR=9.715, 95% CI 1.110-81.969)和肺部感染(P=0.031, HR=25.905, 95% CI 1.381-507.006)是与总体死亡相关的危险因素。展开更多
This paper discussed the coordinated relationship between the real estate and the national economy in a country or region in the views of theoretical analysis and empirical evidences. The results showed that real esta...This paper discussed the coordinated relationship between the real estate and the national economy in a country or region in the views of theoretical analysis and empirical evidences. The results showed that real estate owned the periodical feature and there were bilateral relationship between real estate and national economy. After real estate entered into advanced period, the ratio of real estate added value to GDP may vibrate in a certain range, while the over-heating development of real estate would cause serious impact on the national economy. Compared to the international experience of real estate, real estate in China was still in the process of primary period and had the features of low level of total development and over-heated level of regional development. The macro control on real estate would induce and guarantee the promotion of real estate from primary period to advanced period successfully.展开更多
文摘目的了解中国血液病患者中性粒细胞缺乏(粒缺)伴发热的发生率、临床和微生物学特征及危险因素。方法前瞻性研究2014年10月20日至2015年3月20日来自全国11家血液病中心发生粒缺伴发热的连续血液病患者发热情况及危险性因素。结果1 139例患者共发生784例次粒缺伴发热,粒缺持续21 d时发热的累积发生率为81.9%。多因素分析显示中心静脉置管(P〈0.001,HR= 3.407,95% CI 2.276-4.496 )、胃肠道黏膜炎(P〈0.001,HR=10.548, 95% CI 3.245-28.576)、既往90 d内暴露于广谱抗生素(P〈0.001,HR=3.582,95% CI 2.387-5.770)和粒缺持续时间〉7 d (P〈0.001,HR= 4.194,95% CI 2.572-5.618)是粒缺伴发热的危险因素。无任何危险因素、具备1项、2项、3-4项危险因素患者发热的累计发生率依次增加(35.4%、69.2%、86.1%及95.6%,P〈0.001)。784例次粒缺伴发热中,不明原因发热253例次(32.3%),临床证实的感染429例次(54.7%),微生物学证实的感染102例次(13.0%)。最常见的感染部位依次为肺(388例次,49.5%)、上呼吸道(159例次,16.0%)、肛周组织(77例次,9.8%)、血流(60例次,7.7%)。最常见的病原菌为革兰阴性菌(44.54%),其次为革兰阳性菌(37.99%)和真菌(17.47%)。发热与未发热患者相比,两组之间总体病死率差异无统计学意义(9.2%对4.8%,P=0.099)。多因素分析显示年龄〉40岁(P=0.047 ,HR=5.000 ,95% CI 0.853-28.013 )、血流动力学不稳(P=0.001,HR=13.185, 95% CI 2.983-54.915)、既往耐药菌的定植或感染(P=0.005 ,HR=28.734, 95% CI 2.921-313.744)、血流感染(P=0.038 ,HR=9.715, 95% CI 1.110-81.969)和肺部感染(P=0.031, HR=25.905, 95% CI 1.381-507.006)是与总体死亡相关的危险因素。
文摘This paper discussed the coordinated relationship between the real estate and the national economy in a country or region in the views of theoretical analysis and empirical evidences. The results showed that real estate owned the periodical feature and there were bilateral relationship between real estate and national economy. After real estate entered into advanced period, the ratio of real estate added value to GDP may vibrate in a certain range, while the over-heating development of real estate would cause serious impact on the national economy. Compared to the international experience of real estate, real estate in China was still in the process of primary period and had the features of low level of total development and over-heated level of regional development. The macro control on real estate would induce and guarantee the promotion of real estate from primary period to advanced period successfully.