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目的:探讨侵袭性非霍奇金淋巴瘤(NHL)患者化疗后感染的临床免疫影响因素。方法:选取2008-01-2013-12接受CHOP样方案化疗的98例侵袭性NHL患者,于化疗前检测T淋巴细胞亚群,NK细胞,免疫球蛋白(IgG,IgA,IgM)及补体(C3,C4),调查化疗后(31d内)感染情况。通过单因素与多因素分析了解化疗后感染与临床免疫因素等的关系。结果:98例患者中发生感染29例,占29.6%。感染部位主要为呼吸道,感染程度以CTCAE 3级最多见,病原菌以革兰氏阴性菌为主。单因素分析显示,感染者化疗前CD4+T细胞计数,CD8+T细胞计数,以及IgM均显著小于未感染者[(0.24±0.14)×109/L∶(0.44±0.21)×109/L,(0.29±0.20)×109/L∶(0.43±0.20)×109/L,0.50g/L∶0.70g/L,P<0.05]。二元Logistic回归分析显示,化疗前CD4+T细胞计数与化疗后感染有关(P=0.002,OR0.001,95%CI 0.000~0.060)。结论:化疗前CD4+T细胞计数是侵袭性NHL患者化疗后感染的重要影响因素,CD4+T细胞计数越低,化疗后感染风险越大。
Objective: To investigate the clinical immunological factors of post-chemotherapy infection in patients with aggressive non-Hodgkin’s lymphoma (NHL). Methods: A total of 98 patients with aggressive NHL who underwent CHOP-like chemotherapy were enrolled in this study. T lymphocyte subsets, NK cells, immunoglobulins (IgG, IgA, IgM) and complement , C4) to investigate the infection after chemotherapy (within 31 days). Through single factor and multivariate analysis to understand the relationship between postoperative chemotherapy and clinical immune factors. Results: In 98 cases, 29 cases were found to be infected, accounting for 29.6%. Mainly respiratory tract infection, the level of infection to CTCAE 3 most common, mainly gram-negative bacteria. Univariate analysis showed that CD4 + T cell count, CD8 + T cell count and IgM in patients with chemotherapy before chemotherapy were significantly lower than those in non-infected patients [(0.24 ± 0.14) × 109 / L: (0.44 ± 0.21) × 109 / L, (0.29 ± 0.20) × 109 / L: (0.43 ± 0.20) × 109 / L, 0.50g / L: 0.70g / L, P <0.05]. Binary logistic regression analysis showed that the counts of CD4 + T cells before chemotherapy were related to post-chemotherapy infection (P = 0.002, OR0.001, 95% CI 0.000 ~ 0.060). Conclusion: The counts of CD4 + T cells before chemotherapy are the important influencing factors of infection after chemotherapy in patients with aggressive NHL. The lower the CD4 + T cell count, the higher the risk of infection after chemotherapy.