急性白血病合并感染123例临床分析

Acute Leukemia Patients with Complication of Infection:Their Clinical Features

目的了解急性白血病(acute leukemia,AL)患者并发感染的临床特征。方法回顾分析123例AL患者并发感染的患病率、影响因素、细菌谱及在常规抗感染治疗基础上并用粒细胞集落刺激因子(G-CSF)对疗效的影响。结果AL患者并发感染的患病率为94.3%,革兰阴性(G-)杆菌占42.4%,革兰阳性(G+)球菌占49.2%,真菌占8.4%;血培养G-杆菌以大肠埃希菌及铜绿假单胞菌为主;感染主要与患者中性粒细胞绝对值(N)降低有关;AL患者并发感染总死亡率为6%,发生肺部感染及败血症的患者病死率增高,而使用G-CSF的病死率较低。结论Al患者是并发感染的高危人群,影响因素主要是N减少,在合理使用抗生素治疗的基础上加用G-CSF有助于提高抗感染的疗效。

OBJECTIVE To study the clinical features of acute leukemia （AL） patients with complication of infection. METHODS A retrospective analysis of prevalence of infection occurring in 123 AL patients, their bacterial spectrum, and the effect of G-CSF on the infection were done. RESULTS The prevalence of infection in AL patients was 94.3%, among which 49.2 % were infected with Gram-positive organisms, 42. 4% with Gramnegative bacilli and 8.4% with fungi. Blood culture occurred mostly with Escherichia coli and Pseudomonas infection. Patient＇s neutropenia was significantly related to the infection. The patients with neutrophil count less than 0. 2 × 10^9/L had more frequently suffered severe infection with long-lasting time, and had more than two sites of infection. Age, hemoglobin level, prophylactic intestinal usage of antibiotics could not reduce patient＇s infection. The total mortality of AL patients with infection was 6%. Pulmonary infection and septicemia increased mortality, but G-CSF therapy reduced it. CONCLUSIONS AL patients are at high risk Of infection which is significantly associated with severe neutropenia. G-CSF therapy exerts an assistant role to antibiotics in controlling the infection.