血液系统恶性肿瘤患者化疗后合并中性粒细胞减少性肠炎的诊治研究

Neutropenic enterocolitis in adult patients with hematological malignancy after intensive chemotherapy

目的分析成人血液系统恶性肿瘤患者接受强烈化疗后中性粒细胞减少性肠炎（NE）的发生率、危险因素及预后情况。方法收集2004至2013年接受化疗的1804例血液系统恶性肿瘤患者，记录患者血常规、凝血检测和血液生化检测结果，并记录患者年龄、性别、原发病、既往化疗次数、既往化疗方案中是否使用阿糖胞苷、临床症状、肠壁厚度、中性粒细胞最低计数、中性粒细胞缺乏持续时间、NE的治疗方法和预后等，探讨NE起病诱因、临床特征、腹部B超特点、症状的预后意义及化疗药物对发病的影响等。结果1804例患者中226例（12．5％）化疗后合并NE，化疗后10～19d起病，中位起病时间为化疗后第14天。发生NE后26例患者死亡，病死率11．5％。化疗药物包括阿糖胞苷、临床症状≥4项、中性粒细胞缺乏持续超过7d以及B超下肠壁厚度≥10mm的患者病死率相对较高。结论NE是接受强烈化疗的血液系统肿瘤患者的严重的并发症，发生NE后患者病死率较高。

Objective To review the clinical features, risk factors and outcome of neutropenic enterocolitis （NE） in adult patients with hematological malignancy after intensive chemotherapy. Methods The medical records of 226 adult patients with hematological malignancy and neutropenic enterocolitis receiving intensive chemotherapy from 2004 to 2013 were reviewed. NE was diagnosed based on the symptoms of neutropenic fever, abdominal pain and/or diarrhea, and bowel wall thickening ≥4mm on abdominal sonography or CT. Results Among 1 804 patients with hematological malignancy NE was diagnosed in 226 cases （12.5%）, the median onset time was 14 days （10-19） after chemotherapy, with a death rate of 11.5%. Previous therapy with cytarabine, the clinical findings of 4 or more symptoms, the duration of neutropenia 〉7 days, and an intestinal wall thickness ≥ 10 mm on ultrasonography were associated with case fatality. Conclusion Neutropenic enterocolitis is a rare but severe complication in patients with hematological malignancy undergoing intensive chemotherapy.