本文關(guān)鍵詞： 惡性血液病 侵襲性真菌病 危險(xiǎn)因素 臨床特征 病原菌　出處：《遵義醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:分析惡性血液病合并侵襲性真菌病(IFD)的相關(guān)危險(xiǎn)因素和臨床特征,為侵襲性真菌病的早期診斷提供指導(dǎo)。方法:用回顧性病例對照研究方法,分析我院血液內(nèi)科2013年1月至2016年1月期間住院的惡性血液病患者病例共194例,以真菌感染者97例作為病例組,以無真菌感染者97例作為對照組,收集兩組病例的年齡、基礎(chǔ)疾病、抗生素使用情況、粒細(xì)胞缺乏時(shí)間、糖皮質(zhì)激素使用情況等指標(biāo),進(jìn)行相關(guān)因素分析。單因素分析采用卡方檢驗(yàn),多因素分析采用非條件Logistic回歸分析,數(shù)據(jù)運(yùn)用SPSS17.0軟件進(jìn)行分析。結(jié)果:97例惡性血液病合并侵襲性真菌病患者中,臨床診斷63例,占64.9%,擬診斷30例,占30.9%,確診4例,均為真菌血癥,占4.2%,上述血液病以急性白血病為主,占57.7%(56/97)。感染部位以肺部為主,占78.3%(76/97),癥狀及體征均缺乏特異性。有26例肺部真菌感染,胸部CT有相對特異性改變,以雙肺多發(fā)結(jié)節(jié)伴斑片狀高密度影為主,占50%(13/26),其中伴空洞1例,伴磨玻璃樣變1例。194例惡性血液病患者住院期間共送檢血培養(yǎng)+藥敏標(biāo)本692份,檢出52株菌株(細(xì)菌48株、真菌4株),血培養(yǎng)陽性率約7.5%。單因素分析結(jié)果顯示兩組病例中,年齡、原發(fā)病是否緩解、使用廣譜抗生素時(shí)間、粒細(xì)胞缺乏持續(xù)時(shí)間以及是否合并低蛋白血癥這五個(gè)影響因素構(gòu)成比差異有統(tǒng)計(jì)學(xué)意義(P0.05)。多因素非條件Logistic回歸分析結(jié)果顯示原發(fā)疾病未緩解(P=0.012,OR=2.904)、粒細(xì)胞缺乏時(shí)間≥7天(P=0.000,OR=3.938)、使用糖皮質(zhì)激素≥5d(P=0.005,OR=3.174)、使用廣譜抗生素≥7d(P=0.004,OR=2.730)為惡性血液病合并侵襲性真菌病的獨(dú)立危險(xiǎn)因素。結(jié)論:1.惡性血液病合并侵襲性真菌病,以急性白血病合并真菌感染為主,真菌感染部位不同,其臨床表現(xiàn)不同。微生物學(xué)是診斷真菌感染的重要依據(jù),但血培養(yǎng)陽性率及真菌檢出率低,IFD的確診率不高,臨床多為臨床診斷,病原菌以念珠菌為主。2.原發(fā)疾病未緩解、粒細(xì)胞缺乏持續(xù)時(shí)間長、長期使用廣譜抗生素和糖皮質(zhì)激素是惡性血液病合并侵襲性真菌病獨(dú)立危險(xiǎn)因素。因此臨床工作應(yīng)積極治療原發(fā)病、縮短粒細(xì)胞缺乏時(shí)間,合理運(yùn)用抗生素和糖皮質(zhì)激素,這是減少侵襲性真菌病發(fā)生的重要措施。
[Abstract]:Objective: to analyze the risk factors and clinical characteristics of malignant hematological diseases with invasive mycosis (IFD) in order to provide guidance for the early diagnosis of invasive mycosis. From January 2013 to January 2016, 194 patients with malignant hematological diseases in our hospital were analyzed. 97 cases of fungal infection and 97 cases of non-fungal infection were selected as the case group and 97 cases as the control group. The age of the two groups was collected. The basic diseases, antibiotic use, granulocyte deficiency time, glucocorticoid use and so on were analyzed. Univariate analysis was performed by chi-square test, multivariate analysis by non-conditional Logistic regression analysis. Data were analyzed by SPSS17.0 software. Results among 97 cases of malignant hematologic diseases complicated with invasive mycosis, 63 cases were clinically diagnosed (64.9%), 30 cases were to be diagnosed (30.9%), 4 cases were confirmed as mycemia. The above mentioned hematologic diseases were mainly acute leukemia, accounting for 57.7% 56% 97%. The infection sites were mainly in the lungs, 78.336% 97%, and the symptoms and signs were lack of specificity. There were 26 cases of pulmonary fungal infections, and the chest CT had relatively specific changes. A total of 692 drug-sensitive specimens of blood culture were collected from patients with multiple pulmonary nodules with plaque, including 1 with cavity and 1 with vitreous degeneration. 52 strains (48 strains of bacteria) were detected, among them, 1 case was accompanied by cavity, 1 case was accompanied by vitreous degeneration, 1 case was accompanied by vitreous degeneration, and 692 samples of drug-sensitive blood samples were collected during hospitalization, and 52 strains (48 strains of bacteria) were detected. The positive rate of blood culture was about 7.5%. Univariate analysis showed that in the two groups, age, primary disease remission, duration of use of broad-spectrum antibiotics, The duration of granulocyte deficiency and whether it was complicated with hypoproteinemia were significantly different (P 0.05). Multivariate conditional Logistic regression analysis showed that the primary disease was not alleviated (P < 0.012) and the time of granulocytosis was more than or equal to 2.904. The risk factors of malignant hematologic diseases with invasive mycosis were as follows: 3.938, 3.938, using glucocorticoid 鈮，

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