粒细胞缺乏期以腹部症状为首发感染表现的临床分析

Clinical analysis of abdominal symptoms as the first manifestations of infection in agranulocytosis

目的探讨化疗后粒细胞缺乏期以腹部症状为首发感染表现的临床特点。方法回顾性分析烟台毓璜顶医院2010年1月至2021年3月期间化疗后粒细胞缺乏期以腹部症状为首发感染表现的35例恶性血液病患者,男20例,女15例,中位年龄42岁。观察并记录其临床特征、实验室检查及影像学检查结果的特点。结果35例患者化疗后粒细胞缺乏期间,起初均无发热,但均有不同程度并发腹部症状,表现为不明原因腹痛、腹胀、咽痛、吞咽不适、恶心、呕吐、返酸、呃逆、腹泻等症状,查体发现腹部无固定部位压痛、肠鸣音亢进、腹肌紧张等体征。其中30例粒细胞缺乏患者出现上述症状及体征后才有发热,且热峰时间较长,均大于2 h,实验室检查结果提示C反应蛋白(CRP)、降钙素原均明显升高,1,3-β-D葡聚糖检测(G试验)、半乳甘露聚糖检测(GM试验)无异常,4例粪培养阳性,6例血培养阳性,21例腹部CT为脂膜炎性改变、肠腔胀气、肠管积气及肠管增厚等表现。结论粒细胞缺乏期,感染致死率较高,但不是所有患者均以发热为首发表现,要警惕以腹部症状为首发表现的感染,这群患者表现比较特殊,且腹部症状无特异性表现,极易漏诊,延误诊治,临床需提高警惕;在粒细胞缺乏期一旦出现不明显原因的腹部症状,要及时完善实验室、影像学检查,密切监测体温,及时抗感染治疗,降低患者病死率。

Objective To investigate the clinical characteristics of abdominal symptoms as the first manifestations of infection in agranulocytosis after chemotherapy.Methods This was a retrospective observational study on 35 patients with hematologic malignancy with abdominal symptoms as the first manifestations of infection in agranulocytosis after chemotherapy in Yantai Yuhuangding Hospital from January 2010 to March 2021,including 20 males and 15 females,with a median age of 42 years old.The clinical features,laboratory examination and imaging results were observed and recorded.Results During the stage of agranulocytosis after chemotherapy,none of the 35 patients had fever at the beginning,but all of them had abdominal symptoms to varying degrees,including unexplained abdominal pain,abdominal distension,sore throat,swallowing discomfort,nausea,vomiting,sour regurgitation,hiccups,diarrhea,and other symptoms.Physical examination showed that there were no fixed abdominal tenderness,bowel sounds,and abdominal muscle tension.Among them,30 patients with agranulocytosis had fever only after the above symptoms and signs,and the heat peak time was longer than 2 hours.Laboratory examination results showed that C-reaction protein(CRP)and procalcitonin significantly increased,and G test and GM test were normal.Fecal culture was positive in 4 cases,and blood culture was positive in 6 cases.Abdominal CT showed panniculitis,flatulence,pneumatosis,and intestinal thickening in 21 cases.Conclusions In the agranulocytosis stage,the mortality rate from infection is high,but not all patients present with fever as their first manifestation.Those with abdominal symptoms as the first manifestations of infection need to be paid attention to,this group of patients is special,has no specific manifestations of abdominal symptoms,which is easy to miss diagnosis and delay diagnosis and treatment,and requires clinical vigilance.In the agranulocytosis stage,once there are abdominal symptoms of no obvious causes,timely laboratory and imaging examinations,close monitoring of body temperature,and timely anti-infection treatment should be performed to reduce the mortality rate of patients.