儿童急性白血病化疗医院感染病原菌及其与FcγRⅡA基因多态性的关联

Pathogens isolated from acute leukemia chemotherapy children with nosocomial infection and association with FCγ RⅡA gene polymorphisms

目的 研究急性白血病化疗医院感染患儿病原菌、Fcγ受体ⅡA(FcγRⅡA)基因多态性分布及其影响因素。方法 回顾性收集2019年1月-2022年8月济宁医学院附属医院收治的109例急性白血病化疗患儿临床资料,根据患儿是否发生医院感染将其分为感染组(46例)和未感染组(63例),统计急性白血病化疗患儿医院感染病原菌分布情况,比较两组一般资料、血清生化指标、FcγRⅡA基因多态性,采用多因素Logistic回归分析急性白血病化疗患儿医院感染的影响因素。结果 109例急性白血病化疗患儿发生医院感染共46例,检出病原菌57株,其中革兰阴性菌38株,占比66.67%;革兰阳性菌15株,占比26.32%;真菌4株,占比7.02%;感染组FcγRⅡA基因多态性H型占比低于未感染组,R型占比高于未感染组(P<0.05);多因素Logistic回归分析结果显示,年龄<5岁、化疗阶段为诱导化疗期、抗菌药物使用时间≥5 d、住院时间≥30 d、外周血中性粒细胞(N)、血清白蛋白(ALB)水平较低、FcγRⅡA基因多态性为R型均为急性白血病化疗患儿医院感染的独立影响因素(P<0.05)。结论 急性白血病化疗患儿主要感染病原菌种类为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、链球菌及光滑假丝酵母、白假丝酵母,FcγRⅡA基因多态性分布存在较大差异,其影响因素较多,临床可据此对有相关特征的患儿进行针对性治疗或干预,降低急性白血病化疗患儿医院感染发生的风险。

OBJECTIVE To investigate the distribution of pathogenic bacteria and FC receptor Ⅱ A(FCγ RⅡA)gene polymorphism in nosocomial infection children with acute leukemia after chemotherapy and its influencing factors.METHODS Clinical data of 109 children with acute leukemia treated with chemotherapy in our hospital from Jan 2019 to Aug 2022 were retrospectively collected.According to whether nosocomial infection occurred in the children,they were divided into the infected group(46 cases)and the uninfected group(63 cases).The distribution of pathogenic bacteria in nosocomial infection children with acute leukemia after chemotherapy was analyzed.General data,serum index and FCγ RⅡA gene polymorphism were compared between the two groups.Multivariate logistic regression was used to analyze the risk factors for nosocomial infection in children with acute leukemia chemotherapy.RESULTS A total of 46 cases of nosocomial infection occurred in 109 children with acute leukemia chemotherapy.Fifty-seven strains of pathogenic bacteria were detected,including 38 strains of gramnegative bacteria,accounting for 66.67%,15 strains of gram-positive bacteria,accounting for 26.32% and 4 strains of fungi,accounting for 7.02%.The proportion of H-type of FCγ RⅡA polymorphism in the infected group was lower than that in the uninfected group,while he proportion of R-type was higher(P<0.05).Multivariate logistic regression analysis showed that age<5 years,chemotherapy stage of induction chemotherapy,antibiotic use time≥5 d,hospital stay≥30 d,low levels of neutrophils(N)and serum albumin(ALB)in peripheral blood,and R-type of FCγ RⅡA gene polymorphism were independent risk factors for nosocomial infection in children with acute leukemia chemotherapy(P<0.05).CONCLUSION The main pathogenic bacteria species in children with acute leukemia chemotherapy were Escherichia coli,Klebsiella pneumoniae,Staphylococcus aureus,Streptococcus,Candida glabra and Candida albicans.The difference in the distribution of FCγ RⅡA gene polymorphism was significant,and there were other risk factors for the infection.Targeted treatment or intervention could be carried out on children with related characteristics to reduce the risk of nosocomial infection in children with acute leukemia chemotherapy.