论文部分内容阅读
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 understand the incidence and risk factors of aggressive fungal infections in patients with hematological malignancies and provide basis for the prevention and treatment of fungal infections in critically ill patients. Methods The data of 495 hospitalized patients with hematologic malignancies from January to December in 2013 were retrospectively analyzed. The risk factors of invasive fungal infection were analyzed by the means of chi-square test and multivariate Logistic regression analysis. Results 16.4% (81/495) of patients developed invasive fungal infections. The incidences of fungal infections in patients with acute leukemia, chronic leukemia, myelodysplastic syndrome, lymphoma and multiple myeloma were 31.1% (66/212 ), 0.0% (0/19), 31.2% (5/16), 4.8% (10/207) and 0.0% (0/41). Low peripheral blood leukocyte count≤1.0E + 9 / L, neutropenia time≥8 days, use of glucocorticoid and antibiotics≥3 kinds are the independent risk factors of invasive fungal infection in patients with hematologic malignancies, prophylactic use Antifungal agents were independent protective factors (OR values were 15.830, 41.667, 3.745, 8.264 and 39.085, P values were 0.000, 0.011, 0.035, 0.007 and 0.000, respectively). Conclusion The rational use of antibiotics and glucocorticoids, and the timely use of colony-stimulating factor, antifungal agents or reconstructed micro-ecology in patients with longer agranulocytosis are necessary measures to prevent and treat fungal infections in patients with hematologic malignancies.