急性白血病化疗后侵袭性真菌感染的流行病学调查

Epidemiological investigation of invasive fungal infection after chemotherapy in acute leukemia

目的 分析急性白血病化疗后合并侵袭性真菌感染（IFI）的危险因素.方法 采用回顾性分析,抽取医院2013年2月至2018年2月收治的急性白血病化疗后合并IFI的46例患者作为IFI组;将急性白血病化疗后未合并IFI的患者作为对照组,共54例.调查患者一般情况,采用单因素分析与多因素分析的方法,找出急性白血病患者化疗后合并IFI的危险因素.结果 IFI组患者均伴不同程度发热,以口腔感染及肺部感染为主,真菌培养率为80.43％,其中以假丝酵母菌检出率最高.经单因素分析发现,使用激素、粒细胞缺乏且持续时间长、使用碳青霉素类抗生素、多种抗菌药物使用是急性白血病合并IFI的危险因素（P〈0.05）;经多因素分析发现,粒细胞数〈0.5×109/L、粒细胞缺乏时间长、使用碳青霉烯类抗生素、激素治疗是急性白血病患者合并IFI的危险因素（OR〉1,P〈0.05）.结论 临床上合理使用激素与抗菌药物,及时采取有效的措施帮助患者及时恢复粒细胞数量,是降低急性白血病患者合并IFI风险的关键.

Objective To analyze the risk factors of invasive fungal infections （IFI） complicated with acute leukemia after chemotherapy. Methods By retrospective analysis, the clinical data of patients with IFI complicated with acute leukemia from February 2013 to February 2018 were selected as IFI group, with 46 cases. The patients without IFI complicated with acute leukemia were included in control group, with 54 cases. The general situation of patients was investigated, and single factor analysis and multivariate analysis were used to find out the risk factors of IFI in patients with acute leukemia after chemotherapy. Results All of the patients in IF] group were complicated with different degrees of fever, mainly with oral infection and pulmonary infection, and the rate of fungal culture was 80.43 % , among which the highest rate of candida was detected. By single factor analysis, it was found that the use of hor-mones, the lack of granulocyte and long duration, the use of carbapenem antibiotics, and a variety of antibiotics were the risk factors of IFI in acute leukemia （P 〈0. 05 ）. By multifactor analysis, the number of granulocytes less than 0. 5×10^9/L, long time of granulocytic deficiency, usage of carbapenems antibiotics and hormone therapy were risk factors for IFI in patients with acute leukemia （ OR 〉 1, P 〈0. 05 ）. Conclusions It is the key to reduce the risk of IFI complicated with acute leukemia patients with rational use of hormones and antibiotics and effective measures to help patients recover the number of granulo-cytcs in time.