多发性骨髓瘤化疗患者发生细菌感染的影响因素

Influencing factors of bacterial infection in patients undergoing chemotherapy for multiple myeloma

目的 探讨多发性骨髓瘤(MM)化疗患者发生细菌感染的影响因素。方法 根据是否发生细菌感染将127例MM化疗患者分为感染组(n=71)和未感染组(n=56)。记录两组患者的外周血指标[辅助性T细胞17(Th17)、调节性T细胞(Treg)、白细胞介素(IL)-17、IL-23、IL-10、γ干扰素(INF-γ)]、Durie-Salmon(DS)分期、国际分期系统(ISS)分期、化疗方案及硼替佐米用药方式。采用Logistic回归模型分析MM化疗患者发生细菌感染的影响因素。结果 感染组患者的DS分期和ISS分期均高于未感染组,差异均有统计学意义(P﹤0.05)。感染组患者的Th17、IL-17、IL-23、INF-γ水平及Th17/Treg均明显高于未感染组,Treg、IL-10水平均明显低于未感染组,差异均有统计学意义(P﹤0.01)。多因素Logistic回归分析结果显示,DS分期、ISS分期、Th17/Treg及IL-17、IL-23水平均是MM化疗患者发生细菌感染的独立影响因素(P﹤0.01)。结论 MM化疗患者发生细菌感染与外周血Th17/Treg、IL-17、IL-23及肿瘤分期有关,临床中可根据以上指标评估细菌感染的可能性,从而制订更加合适的治疗方案,延长患者生存期。

Objective To investigate the influencing factors of bacterial infection in patients undergoing chemotherapy for multiple myeloma(MM).Method According to the presence of bacterial infection,127 MM patients undergoing chemotherapy were divided into infected group(n=71) and uninfected group(n=56).The peripheral blood indexes [helper T cell 17(Th17),regulatory T cell(Treg),interleukin(IL)-17,IL-23,IL-10 and interferon-γ(INF-γ)],Durie-Salmon(DS) stage,International Staging System(ISS) stage,chemotherapy regimens,and medication ways of bortezomib in the two groups were recorded.Logistic regression model was used to analyze the influencing factors of bacterial infection in patients undergoing chemotherapy for MM.Result The DS stage and ISS stage of the infected group were higher than those of the uninfected group(P<0.05).The levels of Th17,IL-17,IL-23,INF-γ,and Th17/Treg in the infected group were significantly higher than those in the uninfected group,the levels of Treg and IL-10 were significantly lower than those in the uninfected group(P<0.01).Multivariate Logistic regression analysis showed that DS stage,ISS stage,Th17/Treg,levels of IL-17 and IL-23 were independent influencing factors of bacterial infection in patients undergoing chemotherapy for MM(P<0.01).Conclusion Bacterial infection in patients undergoing chemotherapy for MM is related to peripheral blood Th17/Treg,IL-17,IL-23,and tumor stage.Clinically,the possibility of bacterial infection can be assessed based on above-mentioned physiological indicators to help develop more appropriate treatment plan and prolong the survival of patients.