晚期乳腺癌患者化疗后呼吸道感染的危险因素分析

Risk factors for respiratory tract infections in advanced breast cancer patients after chemotherapy

目的探讨晚期乳腺癌化疗后呼吸道感染的危险因素,为预防其呼吸道感染提供依据。方法分析医院肿瘤科2005年2月-2012年9月171例晚期乳腺癌患者行含铂方案化疗后呼吸道感染的发生率及病原菌分布,并采用logistic回归模型分析晚期乳腺癌患者含铂方案化疗后呼吸道感染的危险因素。结果 171例晚期乳腺癌患者含铂方案化疗后共有55例发生呼吸道感染,占32.16%,其中上呼吸道感染18例,下呼吸道感染37例;检出革兰阳性菌26株占47.27%,革兰阴性菌27株占49.09%,真菌2株占3.64%,排在前3位的病原菌依次为肺炎链球菌、肺炎克雷伯菌和大肠埃希菌;呼吸道感染危险因素有年龄、肺转移、KPS评分、化疗周期、白蛋白、住院时间、化疗方案、联合放疗和抗菌药物使用种类。结论晚期乳腺癌含铂方案化疗后呼吸道感染的发生率较高,以下呼吸道感染为主,主要病原菌为革兰阳性菌和革兰阴性菌,且该类患者呼吸道感染的危险因素较多,应根据患者具体病情进行及时预防。

OBJECTIVE To explore the risk factors for respiratory tract infections in advanced breast cancer panents after chemotherapy so as to provide reference for the prevention of advanced breast cancer. METHODS A total of 171 patients with advanced breast cancer in the tumor hospital from Feb. 2005 to Sep. 2012 were enrolled in the study, then the incidence of respiratory tract infections and the distribution of pathogenic bacteria of these patients treated with platinum-based chemotherapy were analyzed, and the logistic regression model was used for the analy- sis of risk factors for the respiratory tract infections after platinum-based chemotherapy. RESULTS Of 171 patients with advanced breast cancer, a total of 55 cases （32.16~） acquired respiratory tract infection, including 18 cases with upper respiratory tract infections and 37 cases with lower respiratory tract infections. Gram-positive bacilli, gram-negative bacilli, and fungi were 26 strains, 27 strains, and 2 strains, accounting for 47.27%, 49.09 %, and 3.64 %, respectively. The top three pathogens were Streptococcus pneumoniae, Klebsiella pneumoniae, and Escherichia coll. The risk factors for respiratory tract infections in advanced breast cancer after platinum-based chemo- therapy included the age, lung metastases, KPS score, chemotherapy cycle, albumin, length of hospital stay, chemotherapy regimens, chemotherapy combined with radiotherapy, and types of antibiotics used. CONCLUSION The incidence of respiratory tract infections is relatively high in the advanced breast cancer patients after platinumbased chemotherapy, with the lower respiratory tract infections dominant; the gram-positive bacteria and the gram-negative bacteria are the predominant pathogens; there are many risk factors for the respiratory tract infeetions; timely prevention should be conducted in accordance with the specific condition.