再生障碍性贫血患儿血液感染风险因素分析

Analysis of risk factors of bloodstream infection in children with aplastic anemia

目的:探讨再生障碍性贫血(AA)患儿血液感染(BSI)风险因素。方法:回顾性选取2021年3月至2023年3月在本院行免疫抑制治疗(IST)的获得性AA患儿120例,依据治疗后是否并发BSI分为BSI组和非BSI组。收集两组一般资料、实验室资料,采用Logistic多因素回归分析探讨获得性AA患儿并发BSI的相关因素,受试者工作特征(ROC)曲线评价各独立影响因素与联合预测因子对获得性AA患儿并发BSI的预测效能。结果:120例获得性AA患儿IST后并发BSI 25例,BSI发生率为20.83%(25/120)。单因素分析显示,获得性AA患儿并发BSI可能与AA分型、中性粒细胞计数、白蛋白和球蛋白水平有关(P<0.05)。多因素Logistic回归分析发现,AA分型极重型(OR=3.889,95%CI 1.230~12.302)为获得性AA患儿并发BSI独立危险因素,中性粒细胞计数高(OR=0.005,95%CI 0~0.089)、白蛋白水平高(OR=0.792,95%CI 0.692~0.908)为独立保护因素(P<0.05)。绘制ROC曲线可知,各独立影响因素与联合预测因子均对获得性AA患儿并发BSI具有一定预测效能,尤以联合预测因子预测效能最好,曲线下面积(AUC)为0.890。结论:AA患儿BSI风险因素包括极重型AA、中性粒细胞计数低、白蛋白水平低,可据此采取针对性护理干预。

Objective:To probe into the risk factors of bloodstream infection(BSI)in children with aplastic anemia(AA).Methods:A retrospective study was conducted on 120 children with acquired AA who received immunosuppressive therapy(IST)at our hospital from March 2021 to March 2023.Based on the occurrence of BSI post-treatment,the patients were divided into BSI group and non-BSI group.The general and laboratory data of the two groups were collected.Logistic multivariate regression analysis was used to explore the related factors of BSI in children with acquired AA.The receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of independent influencing factors and combined predictors for BSI in children with acquired AA.Results:There were 25 cases of BSI after IST treatment in 120 children with acquired AA,and the incidence of BSI was 20.83%(25/120).Univariate analysis showed that BSI in children with acquired AA might be related to AA classification,neutrophil count,albumin and globulin levels(P<0.05).Multivariate Logistic regression analysis revealed that very severe AA(OR=3.889,95%CI 1.230-12.302)was an independent risk factor for BSI in children with acquired AA,while higher neutrophil count(OR=0.005,95%CI 0-0.089)and higher albumin levels(OR=0.792,95%CI 0.692-0.908)were independent protective factors(P<0.05).The ROC curve showed that all independent influencing factors and combined predictors had certain predictive efficacy for BSI in children with acquired AA,combined predictor had the best predictive efficacy,and the area under the curve(AUC)was 0.890.Conclusion:The risk factors of BSI in children with AA include extremely severe AA,low neutrophil count and low albumin level,and targeted nursing intervention can be taken accordingly.