儿童急性白血病化疗骨髓抑制期发热时的病原学分析

发布时间：2018-04-05 09:19

  本文选题：儿童　切入点：急性白血病　出处：《宁夏医科大学》2017年硕士论文

【摘要】：背景急性白血病(AL)是儿童时期发病率最高的恶性肿瘤,随着医疗水平的不断提高,AL的生存率和缓解率得到很大提高。然而新的化疗方案较之前相比,化疗疗程更长、强度更大,化疗药物在杀死肿瘤细胞的同时,也引起了包括骨髓抑制在内的多种并发症,随之而来的便是感染。骨髓抑制时感染早期,临床感染表现不明显,发热可能是其唯一的表现形式。如何在发热早期明确致病病原,对早期临床经验性治疗有参考意义。目的对我院儿童急性白血病化疗后出现骨髓抑制发热时进行病原分析,通过了解本组AL患儿化疗骨髓抑制期发热原因及病原学分布,对远期临床用药提供参考,通过危险因素的分析,对其早期干预。方法选取2015年12月至2016年12月在宁夏医科大学附属总院儿科诊断明确且化疗的AL患儿51例,且在化疗期间或化疗后进入骨髓抑制期累计361例次,出现发热累计217例次,除一些药物反应外,其余所有患儿出现发热时,均需在抗生素使用前留取血或骨髓培养、血清降钙素原(PCT)测定、C反应蛋白(CRP),感染性发热患儿留取相应的的病原学标本。对所有发热例次的相应发热原因及对病原学进行统计。对发热相关危险因素,如年龄、性别、骨髓抑制程度(中性粒细胞减少程度)进行分析。结果1、本研究中AL化疗骨髓抑制期发热率为60%,发热原因以上、下呼吸感染(发热率为41.5%)最常见,其次为粒细胞减少性发热(Febrile neutropenia,FN)4.5%,胃肠道感染(4.2%),败血症(2.0%)。2、共检出病原36株,病原学检出率为19.3%。3、发热与骨髓抑制程度、年龄有关,与性别无关。结论1.AL化疗引起的骨髓抑制,发热率高达60%,其中非感染性发热占11.2%,感染性发热占88.8%,骨髓抑制发热时感染危险性高。2.AL化疗引起骨髓抑制时发热的原因中主要以呼吸道感染为主,其次为中性粒细胞减少性发热、胃肠道感染、败血症及药物反应。3.AL化疗引起骨髓抑制发热时,病原学检出率较低,为19.3%,其中细菌感染占80.1%,以G-菌为主,为52.8%,G+菌27.8%。4.AL化疗引起骨髓抑制期发热相关风险中,骨髓抑制程度和发热有密切关系,骨髓抑制程度越重,发热率越高。5.AL化疗引起骨髓抑制时,骨髓抑制程度和感染指标阳性率有关,骨髓抑制程度越重,其感染指标阳性率越高,10例诊断为败血症的患儿中PCT值明显增高,且在感染性发热中阳性率较高。
[Abstract]:Background Acute Leukemia (ALL) is a malignant tumor with the highest incidence in childhood. The survival rate and remission rate of AL have been greatly improved with the improvement of medical treatment.However, the new chemotherapy regimen is longer and more intensive than before. Chemotherapy drugs not only kill tumor cells, but also cause many complications, including bone marrow suppression, followed by infection.In the early stage of myelosuppression infection, clinical infection is not obvious, fever may be its only manifestation.How to identify the pathogeny in the early stage of fever has reference significance for early clinical experience therapy.Objective to analyze the pathogenesis of bone marrow suppression fever after chemotherapy in children with acute leukemia in our hospital, and to find out the causes and etiological distribution of bone marrow suppression fever after chemotherapy in this group of AL children, so as to provide a reference for long-term clinical use.Early intervention was carried out through the analysis of risk factors.Methods from December 2015 to December 2016, 51 children with AL diagnosed in pediatrics of affiliated General Hospital of Ningxia Medical University were diagnosed and treated with chemotherapy, and 361 patients entered the period of bone marrow suppression during chemotherapy or after chemotherapy, and 217 cases had fever.Except for some drug reactions, blood or bone marrow culture should be taken before antibiotics were used in all the children with fever. Serum procalcitonin (PCT) was used to determine the C-reactive protein (CRP).The causes of fever and etiology of all fever cases were analyzed.Risk factors associated with fever, such as age, sex, and bone marrow suppression (neutropenia), were analyzed.缁撴灉1,鏈�鐮旂┒涓瑼L鍖栫枟楠ㄩ珦鎶戝埗鏈熷彂鐑�鐜囦福�

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