老年初治多发性骨髓瘤化疗后感染临床特点及预后的多因素分析

Multivariate analysis of clinical characteristics and prognosis of infection after chemotherapy in elderly patients with newly treated multiple myeloma

目的分析初治多发性骨髓瘤(MM)老年患者化疗后感染临床特点及影响预后的多因素,为治疗该病症提供依据。方法回顾性分析2015年1月-2017年1月在华西医院住院治疗的105例老年初治MM患者化疗后的临床资料,根据有无院内感染分为感染组(n=46)和非感染组(n=59),分析感染临床特点和影响因素。结果46例患者化疗期间发生感染,感染率为43.81%,感染部位以呼吸道为主;共分离出病原菌52株,包括革兰阳性菌10株,革兰阴性菌23株,真菌19株。其中革兰阳性菌主要以金黄色葡萄球菌为主,革兰阴性菌主要以肺炎克雷伯菌为主,真菌主要以白色假丝酵母菌为主。Logistic多因素回归分析显示,ISS分期为Ⅲ期、合并糖尿病、合并肾功能不全、ECOG评分≥2分、低蛋白血症及粒细胞减少为化疗后感染的独立危险因素(P<0.05)。结论老年初治MM化疗患者易并发各种病原菌感染,且ISS分期Ⅲ期、合并糖尿病、合并肾功能不全、ECOG评分≥2分、低蛋白血症及粒细胞减少为感染的独立危险因素,临床应积极采取有效的预防措施,以减少感染发生。

Objective To analyze the clinical characteristics of infection in elderly patients with newly treated multiple myeloma(MM)after chemotherapy and the factors affecting the prognosis of the patients,and provide evidence for the treatment of the disease.Methods T he clinical data of 105 elderly patients with newly treated MM hospitalized in the West China Hospital from January 2015 to January 2017 were analyzed retrospectively.According to the presence or absence of nosocomial infection,they were divided into infection group(n=46)and non-infection group(n=59).Their clinical characteristics and influencing factors of infection were analyzed.Results Infection occurred in 46 patients during chemotherapy,and the infection rate was 43.81%.The main infection site was the respiratory tract.A total of 52 strains of pathogens were isolated,including 10 strains of Gram-positive bacteria,23 ones of Gram-negative bacteria and 19 ones of fungi.Grampositive bacteria were mainly Staphylococcus aureus,Gram-negative bacteria were mainly Klebsiella pneumoniae,and fungi were mainly Candida albicans.Logistic multivariate regression analysis showed that ISS stageⅢ,diabetes mellitus,renal insufficiency,ECOG score≥2,hypoproteinemia and neutropenia were independent risk factors for infection after chemotherapy(P<0.05).Conclusion Elderly patients with newly treated MM after chemotherapy are prone to complicated infections caused by various pathogens.ISS stageⅢ,diabetes mellitus,renal insufficiency,ECOG score≥2,hypoproteinemia and neutropenia are independent risk factors of infection.Clinically,effective prevention measures should be carried out actively to reduce the occurrence of infection.