感染相关粒细胞减少症临床研究

Clinical study on the infection related neutropenia

目的粒细胞减少症病因复杂繁多,感染最为常见.本文对近几年我院发生的感染相关的粒细胞减少症141例进行分析,为该领域临床提供参考资料. 方法参照诊断标准, 收集2000年1月～2002年3月住院病人中发生的粒细胞减少症141例;利用ELISA法检测病人血清病毒抗体;利用微软办公软件EXCEL进行数据的统计和分析.结果患者年龄的中位数是24个月(范围:1个月～14岁),3岁以下者占57%;女性和男性之比为1∶1.56; 2000年和2001年1～4月份发病例数明显低于其他时节,而2002年则1～2月有一个发病高峰. 141例患儿中,105例有发热(75%),以发热起病就诊者88例,发热合并症有咳嗽、皮疹、腹泻;伴随疾病中急性上呼吸道感染66例(46%),肺炎22例(16%),急性支气管炎11例(7.8%),轮状病毒肠炎10例(7.1%).118例血清病毒抗体的检测显示80例IgG/IgM均阳性,其中 CBV感染者36例(30.5%). 在<1岁年龄组,ANC1时间中性粒细胞≤500/μl者为46%,在>1岁年龄组,ANC1时间中性粒细胞≤500/μl者为34%;经过从ANC1到ANC2平均间隔3d的随访,在<1岁年龄组,ANC2时间中性粒细胞≥1 000/μl者为50%,在>1岁年龄组,ANC2时间中性粒细胞≥1 500/μl者为20.2%.贫血在>6个月的患者中的发生率为33/130,血小板减少的发生率为47/140; 在ANC1时间,中性粒细胞绝对数值与血红蛋白的相关系数是0.06 (n=141),中性粒细胞绝对数值与血小板的相关系数是0.02(n=141). 46例病毒血清IgG/IgM阳性的患者接受了平均4.5d(2～8d)的干扰素治疗,与未接受干扰素治疗的患者相比,粒细胞的恢复时间无显著性差异(P=0.10);8例患者接受了平均4d(2～8d)的特尔立(GMCSF)治疗.结论粒细胞减少症的发生以年龄幼小者居多;其中接近半数病人的ANC值≤500/μl,易患严重感染;血清病毒抗体(IgG/IgM)的阳性率为80/118,以CBV感染率最高(30.5%);本症还伴随一定比例贫血和血小板减少的发生;干扰素对于ANC的恢复作用不明显,细胞因子的作用尚需大样本长时间的随访和观察.

Objective Infection is the most common reasons for the neutropenia.One hundred and fourty-one cases of infection related neutropenia were analyzed.Methods According to the diagnosis standard, the data of the 141 patients with neutropenia were collected from January 2001 to march 2003.The serum virus antibody was detected using ELISA. The data statistics were analyzed using Microsoft EXCEL.Results The middle age of the patients is 24 months (ranges:1 month to 14 years old).The patients under 3 years old account 57%. The ratio of female to male is 1∶1.56. Among the 141 patients with neutropenia, there are 105 patients with fever (75%).Eighty-eight patients had onset symptoms with fever, associated cough,rash or diarrhea. The associated diseases include upper respiratory infection (46%), pneumonia (16%), acute bronchitis and rotavirus infection (7.1%). Among 118 serum samples, there are 80 with virus IgG and IgM positive. Among them there are 36 with CBV infection (30.5%)。 In the group of the patients under 1 year old, 46% of the patients with the mean value of ANC 1≤500/μl. In the group of the patients above 1 year old, 34% of the patients with ANC 1≤500/μl. With the 3 days follow up, 50% of the patients with ANC 2≥ 1 000 /μl in the younger group and 20.2% of the patients with ANC 2≥1 500/μl in the older group.Thirty-three of 130 patients had anemia.Fourty-seven of 140 patients had thrombocytopenia. There is no significant relation between ANC 1 and hemoglobin or the PLT.Fourty-six patients with the IgG/IgM positive had interferon for a mean of 4.5d(2-8d). Compared with the patients without interferon, the time for ANC recovery has no significant difference(P=0.10).Conclusion Neutropenia is more common in the younger children. Half of the patients had ANC below ≤500/μl,which is susceptibility to the sever infection. The positive rate of IgG/IgM is 80/118,in which CBV infection is on the top (30.5%). This disease is also associated with a certain ratio of anemia and thrombocytopenia. Interferon did not show any effect on the recovery of ANC.