异基因造血干细胞移植术后肺部感染危险因素分析

Risk factors for postoperative pulmonary infection after allogeneic hematopoietic stem cell transplantation

目的对异基因造血干细胞移植术后患者肺部感染的危险因素进行分析。方法选择2008年1月-2015年1月在广东省人民医院进行异基因造血干细胞移植的病例进行回顾性研究,将患者分为术后感染组和非感染组,术后肺部感染的观察时间为30天和100天,收集患者的基本资料(性别、年龄)、临床特征(疾病类型、供体来源、供受体血型、HLA吻合情况、是否术前肺部感染和是否发生GVHD)等。采用单因素和多因素的Logistic回归进行危险因素分析。结果 62例手术患者纳入分析,急性髓系白血病和急性淋巴细胞白血病是主要的疾病类型,分别占38.71%(24/62)和37.10%(23/62)。30天观察期发生术后肺部感染患者35例(56.45%),100天观察期有53例(85.48%)。术后30天观察期内的危险因素分析发现,女性和术前发生肺部感染是移植后肺部感染的危险因素(OR=4.79(95%CI:1.13-20.26),P=0.033;OR=7.58(95%CI:1.82,32.64),P=0.006)。术后100的观察期内未发现有统计学差异的危险因素,但术前肺部感染因素的OR值为9.23(P=0.073)。结论女性和术前肺部感染因素是造血干细胞移植术后患者发生肺部感染的主要危险因素。

Objective To explored the risk factors of pulmonary infection in patients undergoing allogeneic hemato-poietic stem cell transplantation （Allo-HSCT）.Methods The Allo-HSCT patients,between January 2008 and January 2015 in Guangdong general Hospital,were collected.Patients were separated into two group：infection group and non-infection group.The primary and secondary endpoints were 30-day and 100-day postoperative.The information of pa-tients,including demographic data （age,gender）and clinical characteristics（disease types,donor and receptor type, HLA match,preoperative pulmonary infection （PI）and GVHD）,were reviewed.Univariate and multivariate logistic re-gressions were conducted to analyze the risk factors of postoperative PI.Results Total 62 patients were included.The major indications before transplantation are acute myelogenous leukemia （AML）（24/62,38.71%）and acute lympho-blastic leukemia （ALL）（23/62,37.10%）.In the endpoint of 30 days.35 patients （56.45%）occurred postoperative PI,gender and preoperative PI were the risk factors of postoperative PI（OR=4.794,95%CI（1.13,20.26）,P =0.033;OR=7.576,95%CI（1.82,32.64）,P =0.006）.Looking at 100 days,there were no significant risk factors for postoper-ative PI,but odds ratio of preoperative PI were 9.73 although the P value = 0.073.Conclusion Gender and preopera-tive PI are the risk factors of postoperative PI in 30 day endpoint .