老年急性髓系白血病化疗后医院感染的危险因素及临床分析

Nosocomial Infection in Senile Patients with Acute Myelogenous Leukemia after Chemotherapy:Risk Factors and Clinical Analysis

目的研究老年急性髓系白血病(AML)的医院感染病原学、危险因素及临床特点。方法91例老年AML患者接受化疗304例次,对其医院感染率和病死率、感染部位进行观察,并进行病原学检测,分析医院感染与中性粒细胞绝对值、骨髓增生程度、慢性系统性疾病的关系。结果老年AML患者较非老年患者所有医院感染的统计指标增高(P<0.05);下呼吸道、口腔、消化道、皮肤、肛周感染及败血症发生率老年组均高于非老年组(P<0.05),而上呼吸道感染及感染部位不明确者,非老年组较高(P<0.05);真菌感染检出率老年组高于非老年组(P<0.05);诱导缓解化疗阶段老年AML所有医院感染指标均较巩固化疗阶段增高(P<0.05),非标准方案组较标准方案组重度感染例次率减低(P<0.05);中性粒细胞≤0.5×109/L,持续时间>7 d,化疗后第14天骨髓增生低下者医院感染发生率较高(P<0.05),合并慢性系统性疾病者,医院感染发生率与对照组相当(P>0.05)。结论年龄、不同化疗阶段、中性粒细胞减少程度及持续时间、骨髓抑制程度与老年AML医院感染有关,而慢性系统性疾病在有效治疗下并不增加老年AML的医院感染发生率。

OBJECTIVE To study the risk factors and clinical characteristics of nosocomial infection in senile patients with acute myelogenous leukemia who received chemotherapy. METHODS Ninety-one cases of senile patients with acute myelogenous kemia received 304 times of chemotherapy with etiological examination, to analyze the relationship between nosocomial infection and absolute neutrophil count in peripheral blood, the cellularity of the marrow and chronic systemic disorder. RESULTS All indicators of senile patients with acute myelogenous leukemia were higher than those of younger patients （P〈0.05）. Infection rate of senile patients in the lower respiratory tract, oral cavity, gastrointestinal tract, skin, anus and septicemia was higher （P〈0.05）, but the infection rate of upper respiratory tract and uncertain position was lower （P〈0.05） than that of younger patients. Positive rate of fungal infection of senile patients was higher （P〈0. 05）. All indicators of nosocomial in- fection in senile patients during remission-induced chemotherapy were higher than that during concurrent chemora- diotherapy （P〈0.05）. The indicators of severe nosocomial infection patients which received standard chemothera- py protocol were higher than those received nonstandard chemotherapy protocol （P〈0.05）. The absolute neutro- phil count in peripheral blood of patients with nosocomial infection was lower than 500/ml and prolonged over 7 days, but the hypoplasia of bone marrow at 14th day after chemotherapy was especially higher （P〈0.05）, and patients with chronic systemic disorder was equal to the other patients （P〉0.05）. CONCLUSIONS Age, different stage of chemotherapy, the neutrocytopenia level and prolongation, and hypocellularity of bone marrow are related to the nosocomial infection in senile patients with acute myelogenous leukemia, and the chronic systemic disorder is not a risk factor.