老年急性白血病病人化疗后骨髓抑制期感染的临床分析

Clinical research on infection in bone marrow suppression phase after chemotherapy in elderly patients with acute leukemia

目的分析老年急性白血病(AL)病人化疗后骨髓抑制期感染的临床特点,探讨其防治措施。方法回顾性分析2013年1月至2015年12月102例老年AL病人(老年组)及100例中青年AL病人(对照组)化疗后进入骨髓抑制期时感染的发生率,并对其感染率、粒细胞缺乏持续时间、致病菌情况及治疗情况进行比较分析。结果老年组的感染发生率高于对照组(P<0.05),2组内亚组分析显示,与单纯AL比较,白血病合并支气管炎、糖尿病、风湿病等病人的感染发生率相对较高(P<0.01);中性粒细胞计数越低、持续时间越长,感染发生率越高(P<0.05);使用集落刺激因子(G-CSF)合并抗感染治疗组粒细胞缺乏持续的时间较单用抗感染组明显缩短,差异有统计学意义(P<0.01),且在对照组中效果优于老年组(P<0.05)。细菌培养结果显示,2组致病菌均以革兰阴性杆菌为主,如铜绿假单胞菌、大肠埃希菌,其次为革兰阳性球菌,如葡萄球菌属,而真菌最少,如白色念珠菌。结论老年AL病人骨髓抑制期易发生感染,有效的抗生素和粒细胞集落刺激因子的合理应用,可减少老年AL病人化疗后骨髓抑制期感染的发生率并改善预后。

Objective To analyze the clinical characteristics of infection in bone marrow suppression phase after chemotherapy in patients with acute leukemia,and to investigate the strategy of prevention and treatment. Methods 102 elderly patients with acute leukemia（ aged group） and 100 cases of non-elderly patients with acute leukemia（ control group） were recruited from September 2013 to December 2015. The incidence rate of infection in bone marrow suppression phase was analyzed retrospectively. The infection rate, the duration of granulocyte deficiency, pathogenic bacteria and treatment were analyzed and compared. Results The incidence of infection was correlated with whether the patients presented with bronchitis,diabetes,or rheumatic diseases（ P〈0. 01）. The incidence rate of infection was higher in aged group than that in control group（ P〈0. 05）. The lower of neutrophil counts and the longer of the duration,the higher of infection rate was in the two groups（ P〈0. 05）. Granulocyte colony stimulating factor（ G-CSF） group could shorten the duration of granulocyte deficiency,especially in control group（ P〈0. 01）. The main pathogenic bacteria was gram negative bacilli such as pseudomonas aeruginosa,escherichia coli.,followed by gram positive bacteria such as staphylococcus aureus,while there was few fungi such as candida albicans in the two groups. Conclusions The elderly patients with acute leukemia in bone marrow suppression phase after chemotherapy is prone to infection. Effective use of antibiotics and G-CSF can reduce the incidence of bone marrow depression infection and improve prognosis in elderly patients with acute leukemia after chemotherapy.