大剂量化疗治疗高危和复发转移性乳腺癌致粒细胞缺乏症并发热的临床分析

Clinical analysis of high-risk primary and metastatic breast cancer patients with neutropenia and fever after high-dose chemotherapy

目的:探讨高危和复发转移性乳腺癌大剂量化疗后粒细胞缺乏症并发热的发生率、感染及病原菌和治疗措施。方法:收集2004-07-2009-04我科高危和复发转移性乳腺癌进行大剂量化疗病例共145例,分析其临床资料。结果:高危和复发转移性乳腺癌大剂量化疗后粒细胞缺乏症发生率97.2%(141/145)。发热的发生率57.2%(83/145),持续(3.37±1.77)d。发热组和未发热组的中位最低中性粒细胞数分别为0.000×109L-1和0.026×109L-1,χ2=4.563,P=0.033;平均粒细胞缺乏持续时间分别为4.75和3.26 d,t=4.409,P=0.000。微生物学证实的感染病例占8.4%(7/83),临床诊断的感染病例占56.6%(47/83),不明原因发热病例占34.9%(29/83)。常见感染部位咽、口腔和舌体病例占28.9%(24/83),胃肠道病例占24.1%(20/83)。主要病原菌为革兰阴性菌42.9%,经验性抗生素治疗有效率为100.0%。结论:高危和复发转移性乳腺癌大剂量化疗后具有极高的粒细胞缺乏症和发热的发病率,多于1周内出现,持续3～4 d。消化道是其常见感染部位,以革兰阴性菌为主。综合性防治措施有效。

OBJECTIVE：To explore the incidence of febrile neutropenia（FN）,infection,major pathogens,and treatment measures for high-risk primary and metastatic breast cancer patients after high-dose chemotherapy.METHODS：Totally 145 cases of high-dose chemotherapy in high-risk primary and metastatic breast cancer patients from July 2004 to April 2009 were reviewed and analyzed their clinical data was analyzed.RESULTS：The incidence of neutropenia in high-risk primary and metastatic breast cancer patients after high-dose chemotherapy was 97.2%（141/145）.The incidence of FN was 57.2%（83/145）,and the duration of fever was（3.37±1.77） days.The median low nadir of ANC was 0.000×10^9 L^-1 and 0.026×10^9 L^-1 in the fever and normal groups,respectively（χ^2=4.563,P=0.033）,with the mean duration of neutropenia of 4.75 days vs.3.26 days（t=4.409,P=0.000）.There were 8.4%（7/83） microbiologically documented infections,56.6%（47/83） clinically suspected infections and 34.9%（29/83） FUO.The most common focus of infection was the pharynx,mouth and tongue（28.9%） followed by the gastrointestinal tract（24.1%）.Gram-negative microorganisms were the most frequently isolated agents（42.9%）.The overall response rate to empirical antibiotherapy was 100.0%.CONCLUSIONS：There are very high incidences of neutropenia and FN in high-risk primary and metastatic breast cancer patients receiving high-dose chemotherapy,frequently occur in a week for 3 to 4 days.Digestive tract is the common sites of infection,and gram-negative bacteria are the main pathogens.Comprehensive treatment measures are effective.