儿童急性淋巴细胞白血病化疗后感染的临床特征及危险因素分析

Clinical characteristics and risk factors of infection in children with acute lymphoblastic leukemia after chemotherapy

目的探讨儿童急性淋巴细胞白血病化疗后感染的临床特征及危险因素。方法选取2016年6月—2019年6月天津市儿童医院住院治疗的急性淋巴细胞白血病化疗患儿714例。收集患儿年龄、性别、住院时间、住院季节、感染部位、病原微生物物培养结果、实验室检查指标等资料,分析感染的临床特征及危险因素。结果化疗后感染发生率为51.12%,主要感染部位为肺部(26.58%),其次为上呼吸道(15.89%);获取83株病原菌包括革兰阴性菌(48.19%)、革兰阳性菌(32.53%)、病毒(9.64%)、真菌(6.02%)、肺炎支原体(3.61%);急性淋巴细胞白血病患儿化疗后,糖皮质激素治疗、预防性抗菌药物、是否诱导缓解期、住院时间、最低中性粒细胞计数、中性粒细胞缺乏持续时间、最低血红蛋白、化疗次数及不同住院季节的感染率比较,差异有统计学意义(P<0.05);性别、年龄及最低血小板计数的感染率比较,差异无统计学意义(P>0.05);诱导缓解期、住院时间>14 d、最低中性粒细胞计数<0.5×10^9/L、中性粒细胞缺乏持续时间>7 d及化疗次数>3次是化疗后感染的独立危险因素(P<0.05)。结论临床应针对急性淋巴细胞白血病患儿化疗后感染的危险因素采取有效措施加以控制,降低化疗后感染率,减少对患儿病情的影响。

Objective To investigate the risk factors and clinical characteristics of infection in children with acute lymphoblastic leukemia after chemotherapy.Methods A total of 714 cases of children with acute lymphoblastic leukemia undergoing chemotherapy in our hospital were selected,and data including age,length of hospital,season in hospital,gender,site of infection,culture results of pathogenic microorganisms and laboratory examination were collected to analyze the risk factors and clinical characteristics of infection.Results The rate of infection after chemotherapy was 51.12%,and the main infection site was upper respiratory tract(26.58%),followed by pulmonary infection(15.89%).83 pathogenic bacteria were obtained,including gram-negative bacilli(48.19%),gram-positive bacilli(32.53%),viruses(9.64%),fungi(6.02%),and mycoplasma pneumoniae(3.61%).Infection after chemotherapy was associated with glucocorticoids,prophylactic antibiotics,induced remission stage,length of hospital,neutrophils count,neutropenia duration,minimum hemoglobin,times of chemotherapy and season of hospitalization,with statistically significant differences(P<0.05).There was no significant correlation with age,sex,and lowest platelet count(P>0.05).Induced remission stage,long hospital stay,low neutrophil count,neutropenia duration,and frequent chemotherapy were independent risk factors for post-chemotherapy infection(P<0.05).Conclusion It is necessary to take effective measures to control the risk factors of infection after chemotherapy in children with acute lymphoblastic leukemia in clinical,so as to reduce the infection rate after chemotherapy and reduce the impact on the patient's condition.