恶性血液病合并侵袭性真菌病危险因素分析

发布时间：2018-03-01 20:44

  本文关键词： 恶性血液病 侵袭性真菌病 危险因素 临床特征 病原菌　出处：《遵义医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:分析恶性血液病合并侵袭性真菌病(IFD)的相关危险因素和临床特征,为侵袭性真菌病的早期诊断提供指导。方法:用回顾性病例对照研究方法,分析我院血液内科2013年1月至2016年1月期间住院的恶性血液病患者病例共194例,以真菌感染者97例作为病例组,以无真菌感染者97例作为对照组,收集两组病例的年龄、基础疾病、抗生素使用情况、粒细胞缺乏时间、糖皮质激素使用情况等指标,进行相关因素分析。单因素分析采用卡方检验,多因素分析采用非条件Logistic回归分析,数据运用SPSS17.0软件进行分析。结果:97例恶性血液病合并侵袭性真菌病患者中,临床诊断63例,占64.9%,拟诊断30例,占30.9%,确诊4例,均为真菌血症,占4.2%,上述血液病以急性白血病为主,占57.7%(56/97)。感染部位以肺部为主,占78.3%(76/97),症状及体征均缺乏特异性。有26例肺部真菌感染,胸部CT有相对特异性改变,以双肺多发结节伴斑片状高密度影为主,占50%(13/26),其中伴空洞1例,伴磨玻璃样变1例。194例恶性血液病患者住院期间共送检血培养+药敏标本692份,检出52株菌株(细菌48株、真菌4株),血培养阳性率约7.5%。单因素分析结果显示两组病例中,年龄、原发病是否缓解、使用广谱抗生素时间、粒细胞缺乏持续时间以及是否合并低蛋白血症这五个影响因素构成比差异有统计学意义(P0.05)。多因素非条件Logistic回归分析结果显示原发疾病未缓解(P=0.012,OR=2.904)、粒细胞缺乏时间≥7天(P=0.000,OR=3.938)、使用糖皮质激素≥5d(P=0.005,OR=3.174)、使用广谱抗生素≥7d(P=0.004,OR=2.730)为恶性血液病合并侵袭性真菌病的独立危险因素。结论:1.恶性血液病合并侵袭性真菌病,以急性白血病合并真菌感染为主,真菌感染部位不同,其临床表现不同。微生物学是诊断真菌感染的重要依据,但血培养阳性率及真菌检出率低,IFD的确诊率不高,临床多为临床诊断,病原菌以念珠菌为主。2.原发疾病未缓解、粒细胞缺乏持续时间长、长期使用广谱抗生素和糖皮质激素是恶性血液病合并侵袭性真菌病独立危险因素。因此临床工作应积极治疗原发病、缩短粒细胞缺乏时间,合理运用抗生素和糖皮质激素,这是减少侵袭性真菌病发生的重要措施。
[Abstract]:Objective: to analyze the risk factors and clinical characteristics of malignant hematological diseases with invasive mycosis (IFD) in order to provide guidance for the early diagnosis of invasive mycosis. From January 2013 to January 2016, 194 patients with malignant hematological diseases in our hospital were analyzed. 97 cases of fungal infection and 97 cases of non-fungal infection were selected as the case group and 97 cases as the control group. The age of the two groups was collected. The basic diseases, antibiotic use, granulocyte deficiency time, glucocorticoid use and so on were analyzed. Univariate analysis was performed by chi-square test, multivariate analysis by non-conditional Logistic regression analysis. Data were analyzed by SPSS17.0 software. Results among 97 cases of malignant hematologic diseases complicated with invasive mycosis, 63 cases were clinically diagnosed (64.9%), 30 cases were to be diagnosed (30.9%), 4 cases were confirmed as mycemia. The above mentioned hematologic diseases were mainly acute leukemia, accounting for 57.7% 56% 97%. The infection sites were mainly in the lungs, 78.336% 97%, and the symptoms and signs were lack of specificity. There were 26 cases of pulmonary fungal infections, and the chest CT had relatively specific changes. A total of 692 drug-sensitive specimens of blood culture were collected from patients with multiple pulmonary nodules with plaque, including 1 with cavity and 1 with vitreous degeneration. 52 strains (48 strains of bacteria) were detected, among them, 1 case was accompanied by cavity, 1 case was accompanied by vitreous degeneration, 1 case was accompanied by vitreous degeneration, and 692 samples of drug-sensitive blood samples were collected during hospitalization, and 52 strains (48 strains of bacteria) were detected. The positive rate of blood culture was about 7.5%. Univariate analysis showed that in the two groups, age, primary disease remission, duration of use of broad-spectrum antibiotics, The duration of granulocyte deficiency and whether it was complicated with hypoproteinemia were significantly different (P 0.05). Multivariate conditional Logistic regression analysis showed that the primary disease was not alleviated (P < 0.012) and the time of granulocytosis was more than or equal to 2.904. The risk factors of malignant hematologic diseases with invasive mycosis were as follows: 3.938, 3.938, using glucocorticoid 鈮，

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