中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2015年
8期
670-675
,共6页
叶蕾%井丽萍%杨文睿%周康%彭广新%李洋%李园%李建平%宋琳
葉蕾%井麗萍%楊文睿%週康%彭廣新%李洋%李園%李建平%宋琳
협뢰%정려평%양문예%주강%팽엄신%리양%리완%리건평%송림
贫血,再生障碍性%免疫抑制法%感染
貧血,再生障礙性%免疫抑製法%感染
빈혈,재생장애성%면역억제법%감염
Anemia,aplastic%Immunosuppression%Infection
目的 探索围免疫抑制治疗(IST)期(IST前1个月至IST后3个月)感染对重型/极重型再生障碍性贫血(SAA/VSAA)患者IST疗效的影响.方法 回顾性分析一线行IST的105例SAA/VSAA患者临床资料,研究围IST期感染特征及其对IST疗效的影响.结果 全部105例患者中,97例(92.4％)发生270例次围IST期感染,中位感染2(1～7)次,中位发热7(1～47)d,发病部位以呼吸道最为常见,占35.1％.致病微生物明确的感染96例次(35.6％),共检出169株病原菌,以细菌为主,占88.2％.IST前1个月感染与未感染患者IST后6个月血液学反应率比较差异有统计学意义(50.8％对80.0％,P=0.004).ROC曲线优化IST后6个月能否获得血液学反应的感染次数界限值为3次,发热时间界限值为4d.全部105例患者5年总生存(OS)率为76％,感染3次及以上患者5年OS率为(59.6±7.2)％,明显低于感染少于3次患者[(89.5±4.0)％](P＜0.01);发热时间≥4 d患者5年OS率为(63.4±5.8)％,明显低于发热时间＜4d患者(100.0％)(P＜0.01).结论 IST前1个月感染对IST疗效有影响,围IST期感染3次及以上、发热时间≥4d患者IST血液学反应率低,生存时间短.
目的 探索圍免疫抑製治療(IST)期(IST前1箇月至IST後3箇月)感染對重型/極重型再生障礙性貧血(SAA/VSAA)患者IST療效的影響.方法 迴顧性分析一線行IST的105例SAA/VSAA患者臨床資料,研究圍IST期感染特徵及其對IST療效的影響.結果 全部105例患者中,97例(92.4％)髮生270例次圍IST期感染,中位感染2(1～7)次,中位髮熱7(1～47)d,髮病部位以呼吸道最為常見,佔35.1％.緻病微生物明確的感染96例次(35.6％),共檢齣169株病原菌,以細菌為主,佔88.2％.IST前1箇月感染與未感染患者IST後6箇月血液學反應率比較差異有統計學意義(50.8％對80.0％,P=0.004).ROC麯線優化IST後6箇月能否穫得血液學反應的感染次數界限值為3次,髮熱時間界限值為4d.全部105例患者5年總生存(OS)率為76％,感染3次及以上患者5年OS率為(59.6±7.2)％,明顯低于感染少于3次患者[(89.5±4.0)％](P＜0.01);髮熱時間≥4 d患者5年OS率為(63.4±5.8)％,明顯低于髮熱時間＜4d患者(100.0％)(P＜0.01).結論 IST前1箇月感染對IST療效有影響,圍IST期感染3次及以上、髮熱時間≥4d患者IST血液學反應率低,生存時間短.
목적 탐색위면역억제치료(IST)기(IST전1개월지IST후3개월)감염대중형/겁중형재생장애성빈혈(SAA/VSAA)환자IST료효적영향.방법 회고성분석일선행IST적105례SAA/VSAA환자림상자료,연구위IST기감염특정급기대IST료효적영향.결과 전부105례환자중,97례(92.4％)발생270례차위IST기감염,중위감염2(1～7)차,중위발열7(1～47)d,발병부위이호흡도최위상견,점35.1％.치병미생물명학적감염96례차(35.6％),공검출169주병원균,이세균위주,점88.2％.IST전1개월감염여미감염환자IST후6개월혈액학반응솔비교차이유통계학의의(50.8％대80.0％,P=0.004).ROC곡선우화IST후6개월능부획득혈액학반응적감염차수계한치위3차,발열시간계한치위4d.전부105례환자5년총생존(OS)솔위76％,감염3차급이상환자5년OS솔위(59.6±7.2)％,명현저우감염소우3차환자[(89.5±4.0)％](P＜0.01);발열시간≥4 d환자5년OS솔위(63.4±5.8)％,명현저우발열시간＜4d환자(100.0％)(P＜0.01).결론 IST전1개월감염대IST료효유영향,위IST기감염3차급이상、발열시간≥4d환자IST혈액학반응솔저,생존시간단.
Objective To explore the effects ofperi-immunosuppressive treatment (IST) infection on outcomes of severe and very severe aplastic anemia (SAA/VSAA) patients.Methods Medical record and follow-up data of 105 SAA/VSAA who underwent first-line IST were retrospectively analyzed to find out the characters of infections (1 month before to 3 months after IST),and its effects on hematologic response and survival.Results Of 105 patients,a total of 270 febrile episodes were recorded in 97 patients (92.4％) during their peri-IST periods,with the median infections of 2 (1-7) episodes in each patient with the median febrile duration of 7(1-47) days.Respiratory system (35.1％) was the primary anatomic site of infection.Bacteria (88.2％) were common causes of total 169 pathogenic bacteria in 96 clear pathogenic bacteria episodes.And patients who got infection 1 month before IST had much lower 6-month hematologic response rate than their counterpart ones (50.8％ vs 80.0％,P=0.004).Multiple febrile episodes (≥3 times) and the total febrile duration ≥4 days showed the best sensitivity and specificity according to the ROC curve analysis.The 5-year overall survival of the 105 patients was 76％.The 5-year OS of patients with multiple febrile episodes (≥3 times) were much lower than their counterpart ones [(59.6±7.2)％ vs (89.5±4.0)％] (P ＜ 0.01).The 5-year OS of the total febrile duration ≥ 4 days was much lower than their counterpart ones [(63.4 ± 5.8) ％ vs 100.0％] (P ＜ 0.01).Conclusion Infections 1 month before IST were associated with hematologic response.Multiple febrile episodes (≥3 times) and infections with the febrile duration ≥4 days presented inferior hematologic response and survival.
