老年急性髓系白血病患者化疗后肺部感染影响因素分析

Analysis on influencing factors of lung infection after chemotherapy in elderly patients with acute myeloid leukemia

目的探讨急性髓系白血病(AML)患者化疗后肺部感染的影响因素。方法选取2015年1月至2020年1月在该院接受化疗的AML患者200例,根据化疗后是否发生肺部感染分为感染组(115例)和对照组(85例)。采用单因素分析社会人口学资料(性别、年龄、身高、BMI、吸烟)、临床资料[基础类疾病、FMS样酪氨酸激酶3内部串联重复(FLT3-ITD)]、血常规[中性粒细胞(NC)<0.5×10^(9)/L持续时间、NC<2.0×10^(9)/L持续时间、血红蛋白(Hb)、白细胞(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、血小板计数(PLT)]、住院时间、中心静脉置管时间、化疗相关参数(季节、周期、强度和阶段)对AML患者化疗后肺部感染的影响。将单因素分析有统计学差异的参数纳入logistic逐步回归法分析AML患者化疗后肺部感染的影响因素。结果200例AMI患者住院化疗期间无死亡案例。单因素分析结果显示,2组患者的吸烟、恶性肿瘤法英美分型系统(FAB)分型、FLT3-ITD、Hb、CRP、PCT、NC、PLT、化疗强度、化疗阶段、住院时间、NC<0.5×10^(9)/L持续时间及NC<2.0×10^(9)/L持续时间差异有统计学意义(P<0.05)。Logistic回归分析结果显示,FLT3-ITD、NC、CRP及NC<0.5×10^(9)/L持续时间是影响AML患者化疗后肺部感染的因素(P<0.05),其中FLT3-ITD阳性、高CRP及NC<0.5×10^(9)/L持续时间长是AML患者化疗后肺部感染的危险因素(P<0.05),高NC是AML患者化疗后肺部感染的保护因素(P<0.05)。结论FLT3-ITD阳性、高CRP及NC<0.5×10^(9)/L持续时间长是AML患者化疗后肺部感染的高危因素,NC增高是AML患者化疗后肺部感染的保护因素。

Objective To explore the influencing factors of lung infection after chemotherapy in the patients with acute myeloid leukemia(AML).Methods A total of 200 patients with AML receiving chemotherapy in this hospital from January 2015 to January 2020 were selected and divided into the infection group(115 cases)and the control group(85 cases)according to whether lung infection occurred after chemotherapy.The univariate analysis was adopted to analyze the influence of the sociodemographic data(sex,age,height,weight,BMI,smoking),clinical data[basic diseases,FMS-like tyrosine kinase 3 internal tandem duplication(FLT3-ITD)],blood routine[neutrophils cells(NC)<0.5×10^(9)/L duration,NC<2.0×10^(9)/L duration,hemoglobin(Hb),white blood cells(WBC),C-reactive protein(CRP),procalcitonin(PCT),platelet(PLT)]count,length of hospital stay,time of central venous catheterization practice,chemotherapy-related parameters(season,cycle,intensity and stage)on lung infection after chemotherapy in AML patients.The parameters with statistical difference in the univariate analysis were included into the logistic step regression analysis method to analyze the influencing factrs of pulmonary infection after chemotherapy in AML patients.Results There were no death case in 200 cases of AMI during hospitalization chemotherapy period.The univariate analysis results showed that smoking,malignant tumors,FAB type,FLT3-ITD,Hb,CRP,PCT,NC,PLT,chemotherapy intensity,chemotherapy stage,hospital stay,duration of NC<0.5×10^(9)/L,and duration of NC<2.0×10^(9)/L had statistical significant differences between the two groups(P<0.05).The logistic regression analysis results showed that FLT3-ITD,NC,CRP and the duration of NC<0.5×10^(9)/L were the factors affecting lung infection after chemotherapy in AML patients(P<0.05),in which the FLT3-ITD positive,high level of CRP and long duration of NC<0.5×10^(9)/L were the risk factors for lung infection after chemotherapy in AML patients(P<0.05),and high level of NC was a protective factor for lung infection after chemotherapy in AML patients(P<0.05).Conclusion FLT3-ITD positive,high level of CRP and long duration of NC<0.5×10^(9)/L are the high-risk factors for lung infection after chemotherapy in AML patients,and the level of NC increase is a protective factor for lung infection after chemotherapy in AML patients.