重型再生障碍性贫血患者并发感染的临床特征

The clinical features of severe aplastic anemia patients with complication of infection

目的 了解重型再生障碍性贫血 (SAA)患者并发感染的临床特征。方法 回顾性分析2 2 9例SAA患者并发感染的患病率及影响因素 ,SAA患者并发感染的细菌谱 ,在常规抗感染治疗基础上并用GM CSF或G CSF对疗效的影响。结果 SAA患者并发感染的患病率为 86 .0 % ,G+ 菌占5 4 2 % ,G-杆菌占 4 0 .0 % ,真菌占 5 .8% ;血培养G-杆菌以大肠艾希菌及绿脓杆菌为主。感染主要是与患者中性粒细胞绝对值 (N)降低有关 ,N <0 .2× 10 9/L感染率显著增高 ,且感染时间显著延长 ,N <0 1× 10 9/L者易发生 2个部位以上的感染 ;患者年龄、贫血程度、T细胞亚群分布、是否用抗人胸腺细胞球蛋白 (ATG)不影响感染的发生 ;预防性使用氟嗪酸不能减少肠道感染。SAA患者并发感染总病死率为 2 3.1% ,发生肺部感染及败血症的患者病死率增高 ,而使用GM CSF或G CSF组感染的病死率较低。结论 SAA患者是并发感染的高危人群 ,影响感染的主要因素是中性粒细胞减少 ;在合理使用抗生素的基础上并用造血细胞生长因子可能有助于提高抗感染的疗效。

Objective To study the clinical features of severe aplastic anemia (SAA) patients with complication of infection. Methods A retrospective analysis of prevalence of infection occuring in 229 SAA patients, their bacterial spectrum, and the effect of GM-CSF or G-CSF on the infection were done. Result The prevalence of infection in SAA patients was 86.0%, among which 54.2% was infected with gram-positive organisms,40.0% with gram-negative bacilli and 5.8% with fungal infections. Septicemia occurred mostly with E.coli and Pseudomonas infection. Patient's neutropenia was significantly related to the infection. The patients with neutrophil count less than 0.2×10 9/L had more frequent and severe infection. Age, hemoglobin level, subtype of T lymphocytes and antithymocyte globulin therapy were not related to infection. Prophylaxis usage of floxacin could not reduce patient'gastrointestinal infection. The total mortality of SAA patients with infection was 23.1%. Pulmonary infection and septicemia increased mortality,and GM-CSF/G-CSF therapy reduce mortality. Conclusion SAA patients were at high risk of infection which was significantly associated with severe neutropenia. GM-CSF or G-CSF therapy exerts an assistant role to antibiotics in controlling the infections.