摘要
目的探讨恶性血液病侵袭性真菌感染(IFI)的影响因素及真菌感染前后肠道菌群结构的变化情况,为恶性血液病侵袭性真菌感染的诊治提供依据。方法选择医院2010年1月-2015年12月血液科恶性血液病患者1000例,将其中164例IFI患者作为观察组,另选取164例健康者为对照组,采用单因素及多因素logistic分析IFI的影响因素及PCR法检测肠道菌群情况。结果急性白血病和骨髓增生异常综合征、有基础疾病、应用糖皮质激素、抗菌药物应用时间>7d、抗菌药物种类>2种、白细胞计数≤1.0×109/L者IFI的发生率高于淋巴瘤+慢性白血病+多发性骨髓瘤、无基础疾病、未应用糖皮质激素、抗菌药物应用时间≤7d、抗菌药物种类≤2种、白细胞计数>1.0×109/L者(P<0.05);应用糖皮质激素、抗菌药物种类>2种、白细胞计数≤1.0×109/L是IFI的独立危险因素(P<0.05);恶性血液病IFI感染时外周血淋巴细胞、白细胞、中性粒细胞水平(1.13±0.67、7.46±2.14、0.27±0.03)×109/L均明显低于感染前(9.02±1.04、38.24±11.43、3.52±0.86)×109/L(P<0.05);观察组感染前和感染时肠道真菌量明显高于对照组(P<0.05),观察组感染前和感染时细菌量明显低于对照组(P<0.05);观察组感染时真菌量高于感染前(P<0.05),观察组感染时细菌量低于感染前(P<0.05)。结论应用糖皮质激素、抗菌药物种类>2种、白细胞计数≤1.0×109/L是恶性血液病侵袭性真菌感染的独立危险因素,恶性血液病侵袭性真菌感染和肠道真菌量增加、细菌量减少有关。
OBJECTIVE To explore the influencing factors for invasive fungal infection （IFI） in patients with malignant hematologic diseases and observe the changes of intestinal flora structure before and after fungal infection so as to provide guidance for diagnosis and treatment of the malignant hematologic diseases patients with IFI. METHODS A total of 1000 patients with malignant hematologic diseases who were treated in the hematology department from Jan 2010 to Dec 2015 were enrolled in the study, 164 patients with IFI were assigned as the obser- vation group, meanwhile, 164 healthy people were set as the control group. Univariate analysis and multivariate lo- gistic analysis were performed for influencing factors for IFI, and the intestinal flora were detected by means of PCR. RESULTS The incidence rate of IFI was higher in the patients with acute leukemia and myelodysplastie syn- drome, underlying diseases, use of glucocorticoids, time of use of antibiotics more than 7 days, use of more than 2 types of antibiotics, or white blood cell counts no more than 1.0 × 109/L than in the patients with lymphoma plus chronic leukemia plus multiple myeloma, without underlying disease, without use of glucocorticoids, time of use of antibiotics no more than 7 days, use of no more than 2 types of antibiotics, or white blood cell counts more than 1.0× 109/L （P〈0.05）. The independent risk factors for the IFI included the use of glucocorticoids, use of more than 2 types of antibiotics, and white blood cell counts no more than 1.0 ×109/L （P〈0.05）. The levels of peripheral blood lymphocytes, white blood cells, and neutrophils of the patients with malignant hematologic disea- ses were significantly lower after the infection than before the infection [ （1.13 ±0.67, 7.46±2.14, 0. 27±0. 03）×109/L vs （9.02±1.04, 38.24±11.43, 3.52±0.86）× 109/L （P〈0.05）. The intestinal fungi counts of the ob- servation group were remarkably more than those of the control group before and after the infection （P〈0.05） the bacterial colony counts of the observation group were significantly less than those of the control group before and after the infection （P〈0.05）. The fungal colony counts of the observation group were remarkably more after the infection than before the infection （P〈0.05）, and the bacterial colony counts of the observation group were less after the infection than before the infection （P〈0.05）. CONCLUSION The independent risk factors for the IFI in the patients with malignant hematologic diseases include the use of glucocortieoids, use of more than 2 types of antibiotics, and white blood cell counts no more than 1.0 ×109/L. The IFI in the patients with malignant hematologic diseases is associated with the increase of intestinal fungi counts and the decrease of bacterial colony counts.
作者
马闪珊
赵硕
孙冬梅
黄俊伟
MA Shan-shan ZHAO Shuo SUN Dong-mei HUANG Jun-wei(Jinhua Central Hospital, Jinhua, Zhejiang 321000, China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第5期1039-1042,共4页
Chinese Journal of Nosocomiology
基金
浙江省医药卫生一般研究计划基金资助项目(2014KYA015)
关键词
侵袭性
真菌
恶性血液病
肠道菌群
Invasive
Fungus
Malignant hematologic disease
Intestinal flora
