感染相关性血小板减少症273例临床分析

Analysis of Thrombosytopenia in the Stage of Infection: A Report of 273 Cases

目的探究血小板减少与感染的关系。方法回顾性分析2010年6月～2011年6月我院收治的273例急、慢性感染相关性血小板减少症（非血液系统疾病）的临床资料。结果 273例中男150例,女123例,平均年龄58.2（18～96）岁。血小板计数（9～99）×109/L,平均（68.1±23.0）×109/L。引起血小板减少症的感染相关的病因分布：消化系统占40.3%（110例）,呼吸系统33.7%（92例）,泌尿系统6.6%（18例）,神经系统2.9%（8例）,皮肤2.6%（7例）,五官1.8%（5例）,心血管系统1.5%（4例）,其他系统3.7%（10例）,多系统7.0%（19例）。有明确病原学证据的感染196例（71.8%）,包括病毒占28.2%（77例）,细菌28.2%（77例）,真菌15.4%（42例）;未能明确病原体的感染28.2%（77例）。疾病伴随症状和辅助检查：发热27.1%（74例）,血培养阳性8.4%（23例）,痰培养阳性25.3%（69例）,中性粒细胞增多24.5%（67）。细菌感染引起的血小板减少最低值较病毒感染低,差异有统计学意义（P〈0.05）;细菌与真菌、病毒与真菌感染引起血小板减少最低值无显著差异。结论感染相关性血小板减少症中以病毒、细菌感染最常见,其次为真菌感染;与病毒感染相比,细菌感染引起血小板降低更明显。

Objective To investigate the cause and disease distribution of thromosytopenia in infected patients. Methods A retrospective analysis was conducted in 273 patients with acute and chronic infectionassociated thrombosytopenia from June 2010 to June 2011. Results A total of 273 patients（ 150 men and 123women,mean age 58. 2 years,range from 18 ～ 96 years） were studied. The causes of infection-associated thrombosytopenia were distributed over digestive system（ 40. 3%,110 /273）,respiratory system（ 33. 7%,92 /273）,multisystem（ 7. 0%,19 /273）,urinary system（ 6. 6%,18 /273）,other system（ 3. 7%,10 /273）,nervous system（ 2. 9%,8 /273）,dermal system（ 2. 6%,7 /273）,facial features system（ 1. 8%,5 /273） and cardiovascular system（ 1. 5%,4 /273）. Pathogens detected positively（ 71. 8%,196 /273） were constitutive of virus（ 28.2%,77/273）,bacterium（ 28.2%,77/273）,fungus（ 15.4%,42/273） whereas pathogens detected negatively were 28. 2%（ 77 /273）. The main symptom and laboratory examination were fever（ 27. 1%,74 /273）,blood culture positive（ 7. 7%,21 /273）,sputum positive（ 24. 9%,68 /273） and increased total-WBC number（ 24.5%,67/273）. The mean platelet count of 273 patients was（ 68.1 ±23.0） ×109/L,ranging from 9 ～ 99× 109/L. The minimum value of thrombocytopenia caused by bacterium was significantly lower compared with virus（ P〈0. 05）. There were no significantly different about the minimum value of thrombocytopenia caused by virus compared with fungus and bacterium compared with fungus. Conclusion Among the pathogens which lead to thrombocytopenia,virus and bacterium occupy first and second place and fungus comes third.The value of thrombocytopenia caused by bacterium was significantly lower compared with virus. Compared with fungus,no significantly different value of thrombocytopenia caused by virus and bacterium.