再生障碍性贫血并发感染的临床特征及相关因素分析

Clinical Features and Related Factors of Infections in Patients with Aplastic Anemia

目的分析再生障碍性贫血(AA)并发感染的临床特征及相关因素。方法回顾性收集2014年1月-2017年12月武汉大学中南医院血液科收治的350例AA患者的临床资料,包括性别、年龄、BMI、吸烟及饮酒情况、住院时间、粒细胞缺乏持续时间、中性粒细胞、白细胞、血红蛋白和白蛋白水平以及是否使用激素、是否进行侵袭性操作、是否发生感染、感染菌株等。采用逻辑回归分析不同因素与AA患者感染的相关性。结果本研究共纳入350例AA患者,其中135例发生感染,感染率为38.6%。常见感染部位依次为肺部、消化道、上呼吸道、口腔、皮肤、泌尿系统和肛周脓肿等。病原菌中革兰氏阴性菌占53.45%,革兰氏阳性菌占32.76%,真菌占13.79%。感染组和非感染组的性别、年龄、BMI、吸烟、饮酒和血红蛋白水平差异无统计学意义(P>0.05),而住院时间、粒细胞缺乏时间、中性粒细胞、白细胞、白蛋白水平以及侵袭性操作、激素使用方面具有显著统计学差异(P<0.05)。多因素分析结果表明住院时间、粒细胞缺乏时间、中性粒细胞、白蛋白水平均为AA患者发生感染的独立风险因素(P<0.05)。结论住院时间、粒细胞缺乏时间、中性粒细胞、白蛋白水平均为AA患者发生感染的独立风险因素,临床应重视风险因素以控制感染风险。

Objective To analyze the clinical features and related factors of infections in patients with aplastic anemia（AA）. Methods A total of 350 patients with AA were recruited retrospectively at the Department of Hematology of Zhongnan Hospital of Wuhan University between 2014 and 2017. The clinical data of all these patients was collected, including gender, age,BMI, smoking and drinking status, length of hospital stay, duration of neutropenia , neutrophil, white blood cells, hemoglobinand albumin levels, the use of hormones and invasive procedures, infections, and strains of pathogens. Logistic regression analysis was used to analyze the correlations between different factors and the risk of infection in patients with AA. Results A total of350 patients with AA were enrolled in the study, 135 of whom were infected, and the infection rate was 38. 6%. Common infection sites were the lung, digestive tract, upper respiratory tract, mouth, skin, urinary system and perianal abscess. Gram-negative bacteria accounted for 53. 45% of the pathogens, Gram-positive bacteria 32. 76%, and fungi 13. 79%. There was no significant difference in gender, age, BMI, smoking, alcohol consumption, or hemoglobin levels between the infected and non-infected groups （P〉0. 05）, but there was significant difference in the length of hospital stay, duration of neutropenia, neutrophils,white blood cells, albumin levels, and use of invasive procedures and hormones （P〈0. 05）. Multivariate analysis showed thatthe length of hospital stay, duration of neutropenia, neutrophil and albumin levels were independent risk factors for infections inAA patients （P〈0. 05）. Conclusion The length of hospital stay, duration of neutropenia, neutrophil and albumin levels are independent risk factors for infections in AA patients.