124例多发性骨髓瘤合并肺部感染患者相关危险因素分析

Analysis of related risk factors in 124 cases of multiple myeloma complicating pulmonary infection

目的通过分析多发性骨髓瘤合并肺部感染患者的临床特征,明确其相关危险因素,为提高诊疗水平提供帮助。方法回顾性分析2018年1-6月该院收治的124例多发性骨髓瘤患者的临床资料,对患者的一般情况、多发性骨髓瘤和肺部感染的临床表现进行单因素χ^2检验,采用Logistic回归分析多发性骨髓瘤患者发生肺部感染的危险因素。结果多发性骨髓瘤伴肺部感染的患者外周血白细胞计数或中性粒细胞比例可不增高,降钙素原或C反应蛋白水平增高,肺部感染多累及双肺,细菌和真菌混合感染的比例占感染患者的53.7%。感染组年龄≥60岁、国际分期体系(ISS分期)Ⅲ期、清蛋白<35 g/L及住院天数>10 d的患者比例高于非感染组,差异均有统计学意义(P<0.05);Logistic回归分析显示,住院天数>10 d和血清清蛋白<35 g/L是多发性骨髓瘤患者罹患肺部感染的主要危险因素。结论缩短住院天数,提高血清清蛋白水平,加强ISS分期Ⅲ期,尤其是年龄≥60岁患者呼吸道感染的预防工作,能降低多发性骨髓瘤患者并发肺部感染的概率。

Objective To clear and definite the related risk factors by analyzing the clinical characteristics in the patients with multiple myeloma(MM)complicating pulmonary infection to provide the help for increasing the diagnostic and treatment levels.Methods The clinical data in 124 patients with MM from January to June 2018 were retrospectively analyzed.The single factor Chi-square test was conducted on the general data of the patients,and clinical manifestations of MM and pulmonary infection.The Logistic regression was adopted to analyze the risk factors for pulmonary infection occurrence in MM patients.Results In the patients with MM complicating pulmonary infection,the peripheral white blood cell count or neutrophil percentage could not increase,and the level of PCT or CRP increased.CT scan revealed that infection usually affected bilateral lungs,the proportion of bacterial and fungal mixed infection accounted for 53.7%of infected patients,the proportion of the patients with age≥60 years old,ISS stageⅢ,albumin level<35 g/L and hospitalization days>10 d in the infection group were significantly higher than those in the non-infection group,and the differences were statistically significant(P<0.05).The Logistic regression analysis results showed that serum albumin level<35 g/L and hospitalization days>10 d were the most important risk factors for suffering from pulmonary infection in MM patients.Conclusion Shortening the hospitalization days,increasing serum albumin level and strengthening the respiratory tract infection management in the patients with ISS stageⅢ,especially the patients with age≥60 years old,may reduce the probability of MM patients complicating pulmonary infection.