恶性血液病患者中性粒细胞缺乏伴发热的临床及微生物特征

发布时间：2018-08-09 18:37

【摘要】：目的了解恶性血液病患者中性粒细胞缺乏(粒缺)伴发热的临床及微生物特征。方法回顾性研究某中心发生粒缺的恶性血液病患者的临床资料。结果粒缺伴发热512例次;粒缺持续时间、严重粒缺、体能状况差、90 d内有抗生素暴露史及中心静脉置管是粒缺伴发热的独立危险因素。明确感染部位328例(64.06%),不明原因发热(FUO)184例(35.94%)。微生物中革兰阴性菌占64.35%,革兰阳性菌(23.61%)和真菌(12.04%),共检出57株耐药菌。肺部感染病死率高于FUO(P0.005),肺部感染与血流感染(P0.25)、血流感染与FUO(P0.1)间病死率差异无显著性。结论多种因素与恶性血液病患者粒缺伴发热密切相关,肺部感染最为常见并是主要致死原因。病原微生物以革兰阴性菌为主,其次为革兰阳性菌,且耐药率高。了解这类患者流行病学动态,对临床诊疗有重要指导意义。
[Abstract]:Objective to investigate the clinical and microbiological characteristics of neutrophilic granulocytosis with fever in patients with malignant hematologic diseases. Methods the clinical data of malignant hematologic diseases with granulocytosis in a center were retrospectively studied. Results there were 512 cases of hypogranulocytosis with fever, the duration of grain deficiency, severe lack of grains, history of exposure to antibiotics within 90 days of poor physical condition and central venous catheterization were independent risk factors of fever. The location of infection was identified in 328 cases (64.06%) and fever of unknown origin in 184 cases (35.94%). Gram-negative bacteria accounted for 64.35%, Gram-positive bacteria (23.61%) and fungi (12.04%), 57 strains of drug-resistant bacteria were detected. The mortality of pulmonary infection was higher than that of FUO (P0. 005). There was no significant difference between pulmonary infection and blood flow infection (P0. 25) and between blood flow infection and FUO (P0. 1). Conclusion multiple factors are closely related to hypogranulocytosis and fever in patients with malignant hematologic diseases. Pulmonary infection is the most common and the main cause of death. Gram-negative bacteria were the main pathogens, followed by Gram-positive bacteria, and the drug resistance rate was high. It is important for clinical diagnosis and treatment to understand the epidemiological trends of this kind of patients.
【作者单位】：天津医科大学第四中心临床学院血液科;
【分类号】：R733

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