上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

恶性血液病化疗后粒细胞缺乏期医院感染危险因素的分析

毛原飞1，游建华1，张莉娜2，李啸扬1，刘 钊1，沈 杨1，李军民1   

  1. 上海交通大学 1.医学院附属瑞金医院血液科， 上海 200025； 2.基础医学院生物统计学教研室， 上海 200025
  • 出版日期:2014-01-28 发布日期:2014-01-29
  • 通讯作者: 李军民, 电子信箱: lijunmin@medmail.com.cn。
  • 作者简介:毛原飞（1981—）， 女， 主治医师， 学士; 电子信箱: morfycell@163.com。

Risk factors for nosocomial infection in agranulocytosis patients after chemotherapy to hematological malignancy

MAO Yuan-fei1, YOU Jian-hua1, ZHANG Li-na2, LI Xiao-yang1, LIU Zhao1, SHEN Yang1, LI Jun-min1   

  1. 1.Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; 2.Department of Biostatistics, Basic Medical College, Shanghai Jiao Tong University, Shanghai 200025, China
  • Online:2014-01-28 Published:2014-01-29

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摘要：

目的 探讨恶性血液病化疗后粒细胞缺乏患者的机体状态和医院感染的相关性，并分析引起医院感染的危险因素。方法 回顾性分析2012年7月—2013年6月上海瑞金医院血液科因恶性血液病入院化疗并在住院期间发生粒细胞缺乏患者的各项临床和实验室检查指标，根据住院治疗期间是否发生医院感染分为无医院感染组（n=68）、临床诊断医院感染组（n=84）和病原学诊断医院感染组（n=62）。三组资料进行单因素分析后，用无序多分类Logistic逐步回归模型进行多因素分析。结果 医院感染的发病率为68.22%。多因素分析结果筛选出急性髓系白血病（AML）、住院季节、白细胞计数<0.8×109/L和感染前未使用抗生素预防是发生医院感染的独立危险因素。结论 恶性血液病患者化疗后粒细胞缺乏期间医院感染发病率高，应积极对症支持治疗。尤其对于原发病为AML、夏秋季住院化疗和化疗后白细胞计数最低值<0.8×109/L的患者予以抗生素预防可能减少医院感染的发生。

关键词: 恶性血液病, 化疗, 粒细胞缺乏, 医院感染, 危险因素

Abstract:

Objective To investigate correlation between nosocomial infection and the characteristics of agranulocytosis patients after chemotherapy to hematological malignancy, and to explore the risk factors. Methods By means of the retrospective study, the clinical and laboratory parameters of 214 agranulocytosis patients between July 2012 and June 2013 were analyzed. Among them, 68 without any infection were selected as group A; 84 with clinical diagnosis nosocomial infection, group B; and the rest 62 with etiology diagnosis nosocomial infection, group C. The data were analyzed with iterative multinomial logistic regression model after single factor analysis. Results The incidence of nosocomial infection was 68.22%. The results showed that acute myeloid leukemia (AML), seasons of hospitalization, WBC<0.8×109/L, and no prophylactic antibiotics before infection were independent risk factors of nosocomial infection. Conclusion The incidence of nosocomial infection in agranulocytosis patients after chemotherapy to hematological malignancy is high. In order to improve treatment and prolong survival periods of these patients, good efforts should be taken on to prevent nosocomial infection. Prophylactic antibiotics may reduce the incidence of nosocomial infection, especially for the patients with AML, admitted in summer or autumn, or WBC<0.8×109/L.

Key words: hematological malignancy, chemotherapy, agranulocytosis, nosocomial infection, risk factors