中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2011年
8期
507-511
,共5页
宋阿霞%黄勇%杨栋林%魏嘉璘%阎嶂松%王玫%姜尔烈%庞爱明%马巧玲%翟卫华%张荣莉%冯四洲%韩明哲
宋阿霞%黃勇%楊棟林%魏嘉璘%閻嶂鬆%王玫%薑爾烈%龐愛明%馬巧玲%翟衛華%張榮莉%馮四洲%韓明哲
송아하%황용%양동림%위가린%염장송%왕매%강이렬%방애명%마교령%적위화%장영리%풍사주%한명철
侵袭性真菌感染%血液病%化学疗法%造血干细胞移植%危险因素
侵襲性真菌感染%血液病%化學療法%造血榦細胞移植%危險因素
침습성진균감염%혈액병%화학요법%조혈간세포이식%위험인소
Invasive fungal infections%Hematological diseases%Chemotherapy%Hematopoietic stem cell transplantation%Risk factors
目的 分析血液系统疾病患者侵袭性真菌感染(IFI)的发生率、危险因素、预后和高危人群.方法 回顾性分析2007年1月1日至2008年12月31日在我院移植中心住院时间≥2周的病例.应用逻辑回归、递归分割等方法分析IFI的危险因素和高危人群,IFI发生率的估计应用累积发生率,预后分析应用Kaplan-Meier生存分析.结果 以入院为观察起点,随访至2010年3月30日,中位随访时间260(14～1100)d,可分析的病例共451例,可分析的治疗周期共计1048个.按照治疗周期计算,IFI发生率8.87/100个治疗周期,多因素逻辑回归发现:年龄(OR=1.025,95%CI 1.010～1.041,P=0.002)、粒细胞缺乏(粒缺)时间(OR=1.028,95%CI 1.014～1.042,P＜0.01)及活动性基础疾病(OR=2.620,95%CI 1.608～4.268,P=0.0001)是IFI的独立危险因素.递归分割发现IFI的高危人群有如下特点:①活动性基础疾病,粒缺时间≥58 d(12例中7例,58.3%);②活动性基础疾病,年龄≥33岁(208例中40例,19.2%).随访期末,451例患者中共计111例发生IFI,1年累积发生率27.1%;对于IFI病例,诊断后12周的总体生存率和IFI相关病死率分别为83.4%和13.5%.结论 IFI的危险因素包括年龄、粒缺时间和活动性基础疾病;年龄≥33岁、具有活动性基础疾病的患者是IFI的主要的高危人群,需要引起关注.IFI预后较好,IFI相关病死率较低.
目的 分析血液繫統疾病患者侵襲性真菌感染(IFI)的髮生率、危險因素、預後和高危人群.方法 迴顧性分析2007年1月1日至2008年12月31日在我院移植中心住院時間≥2週的病例.應用邏輯迴歸、遞歸分割等方法分析IFI的危險因素和高危人群,IFI髮生率的估計應用纍積髮生率,預後分析應用Kaplan-Meier生存分析.結果 以入院為觀察起點,隨訪至2010年3月30日,中位隨訪時間260(14～1100)d,可分析的病例共451例,可分析的治療週期共計1048箇.按照治療週期計算,IFI髮生率8.87/100箇治療週期,多因素邏輯迴歸髮現:年齡(OR=1.025,95%CI 1.010～1.041,P=0.002)、粒細胞缺乏(粒缺)時間(OR=1.028,95%CI 1.014～1.042,P＜0.01)及活動性基礎疾病(OR=2.620,95%CI 1.608～4.268,P=0.0001)是IFI的獨立危險因素.遞歸分割髮現IFI的高危人群有如下特點:①活動性基礎疾病,粒缺時間≥58 d(12例中7例,58.3%);②活動性基礎疾病,年齡≥33歲(208例中40例,19.2%).隨訪期末,451例患者中共計111例髮生IFI,1年纍積髮生率27.1%;對于IFI病例,診斷後12週的總體生存率和IFI相關病死率分彆為83.4%和13.5%.結論 IFI的危險因素包括年齡、粒缺時間和活動性基礎疾病;年齡≥33歲、具有活動性基礎疾病的患者是IFI的主要的高危人群,需要引起關註.IFI預後較好,IFI相關病死率較低.
목적 분석혈액계통질병환자침습성진균감염(IFI)적발생솔、위험인소、예후화고위인군.방법 회고성분석2007년1월1일지2008년12월31일재아원이식중심주원시간≥2주적병례.응용라집회귀、체귀분할등방법분석IFI적위험인소화고위인군,IFI발생솔적고계응용루적발생솔,예후분석응용Kaplan-Meier생존분석.결과 이입원위관찰기점,수방지2010년3월30일,중위수방시간260(14～1100)d,가분석적병례공451례,가분석적치료주기공계1048개.안조치료주기계산,IFI발생솔8.87/100개치료주기,다인소라집회귀발현:년령(OR=1.025,95%CI 1.010～1.041,P=0.002)、립세포결핍(립결)시간(OR=1.028,95%CI 1.014～1.042,P＜0.01)급활동성기출질병(OR=2.620,95%CI 1.608～4.268,P=0.0001)시IFI적독립위험인소.체귀분할발현IFI적고위인군유여하특점:①활동성기출질병,립결시간≥58 d(12례중7례,58.3%);②활동성기출질병,년령≥33세(208례중40례,19.2%).수방기말,451례환자중공계111례발생IFI,1년루적발생솔27.1%;대우IFI병례,진단후12주적총체생존솔화IFI상관병사솔분별위83.4%화13.5%.결론 IFI적위험인소포괄년령、립결시간화활동성기출질병;년령≥33세、구유활동성기출질병적환자시IFI적주요적고위인군,수요인기관주.IFI예후교호,IFI상관병사솔교저.
Objective To investigate the incidence, risk factors, prognosis and high risk patients of invasive fungal infections (IFI) in patients with hematological diseases.Methods Over 2-week hospitalized patients from January 2007 to December 2008 were retrospectively reviewed.Logistic regression was used to analyze the risk factors of IFI, and recursive partitioning to reveal high risk patients.Incidence of IFI was estimated by cumulative incidence function, and the prognosis by Kaplan-Meier method.Results A total of 1048 assessible treatment cycles were recorded and 93 cases of IFI were diagnosed, with an incidence of 8.87 per 100 treament cycles.Multivariate logistic regression revealed the following risk factors: age (OR 1.025,95%CI 1.010 - 1.041, P =0.002), duration of neutropenia ( OR 1.028, 95% CI 1.014 - 1.042, P ＜0.0001 ) and uncontrolled underlying diseases ( OR 2.620, 95% CI 1.608 -4.268, P =0.0001 ).Recursive partitioning found two groups of high risk patients: ①patients with uncontrolled underlying diseases and neutropenia duration ≥ 58 days (7/12, 58.3% ), ②patients with uncontrolled underlying diseases and age ≥33 years (40/208, 19.2% ).At the end of follow-up, 111 cases of IFI were recorded in 451 patients, with a 1-year cumulative incidence of 27.1%.In patients with established IFI, overall survival rate and IFI related mortality rate at 12 weeks after diagnosis were 83.4% and 13.5% respectively.Conclusion Age, duration of neutropenia and uncontrolled underlying diseases are risk factors of IFI; patients with uncontrolled underlying diseases and age ≥ 33 years were at high risk of IFI and need major concern.IFI has a better prognosis and a lower related mortality in this study.
