血液病患者侵袭性真菌感染危险评分系统的建立

Establishment of Scoring System for Risk Factors of Invasive Fungal Infection in Patients with Hematologic Diseases

目的:建立识别血液病患者侵袭性真菌感染(IFI)高风险人群的风险评分系统。方法:对2008年1月-2015年12月200例诊断为IFI患者的病例资料和同时期200例对照病例进行危险因素调查,对可能的危险因素进行单因素及Logistic多因素回归分析,筛选出IFI的危险因素并分别赋值。建立IFI风险评分系统,运用接收者工作特征曲线(ROC)评价该评分系统的效能。运用该评分系统对2016年1-6月的103例患者(验证组)进行评分,并比较各得分组IFI发生率。利用评分系统对18例高危患者(干预组)进行干预。结果:社区获得性感染、中性粒细胞降低、真菌感染病史、糖皮质激素、广谱抗菌药物(加酶抑制剂、糖肽类、喹诺酮类、氨基糖苷类和碳青霉烯类)是IFI的危险因素(P<0.001),根据回归系数分别赋分17、10、39、14、14。IFI风险评分系统分为低、中、高危(评分分别为0~30、31~40、≥41分),ROC的AUC为0.916。验证组患者低、中、高危组患者IFI发生率分别为3.0%、10.7%、62.5%,高危组显著高于低、中危组(P<0.05)。干预组患者IFI发生率为16.7%,与验证组的高危组比较差异有统计学意义(P<0.05)。结论:该评分系统区分危险分层能力良好,可有针对性地帮助临床医师识别IFI高风险人群,指导对患者的及时干预。

OBJECTIVE： To establish a risk scoring system for identifying invasive fungal infection（IFI）patients with hematologic diseases. METHODS：Risk factors were investigated among 200 patients diagnosed with IFI and 200 control patients at the same time from Jan. 2008 to Dec. 2015. The single factor analysis and Logistic multivariate regression analysis were conducted for potential risk factors to screen and assign risk factors of IFI. The risk scoring system of IFI was established,the performance of scoring system was evaluated by receiver operating characteristic（ROC） curve. Using the scoring system,103 patients of validation group were scored during Jan. to Jun. in 2016. The incidence of IFI in each group was compared. 18 high-risk patients were intervened by the scoring system. RESULTS：Community acquired infection,the reduction of neutrophils,fungal infection history,corticosteroids and broad-spectrum antibiotics（Enzyme inhibitors,glycopeptides,quinolones,aminoglycosides and carbapenems）were risk factors of IFI（P〈0.001）,and the score of them were 17,10,39,14,14 according to the regression coefficients. IFI risk scoring system was divided into low,medium and high risk（scoring 0-30,31-40,≥41）,AUC of ROC curve was 0.916. The incidence of IFI in low-risk,medium-risk and high risk groups were 3.0%,10.7% and 62.5%,high-risk group was significantly higher than low and medium-risk groups（P〈0.05）. The incidence of IFI was 16.7% in intervention group,there was statistical significance compared to high-risk group of validation group（P〈0.05）. CONCLUSIONS：This scoring system shows good ability to distinguish risk stratification. It can help clinicians identifying IFI high-risk groups and timely guiding timely intervention for patients.