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目的:探讨高危和复发转移性乳腺癌大剂量化疗后粒细胞缺乏症并发热的发生率、感染及病原菌和治疗措施。方法:收集2004-07-2009-04我科高危和复发转移性乳腺癌进行大剂量化疗病例共145例,分析其临床资料。结果:高危和复发转移性乳腺癌大剂量化疗后粒细胞缺乏症发生率97.2%(141/145)。发热的发生率57.2%(83/145),持续(3.37±1.77)d。发热组和未发热组的中位最低中性粒细胞数分别为0.000×109L-1和0.026×109L-1,χ2=4.563,P=0.033;平均粒细胞缺乏持续时间分别为4.75和3.26 d,t=4.409,P=0.000。微生物学证实的感染病例占8.4%(7/83),临床诊断的感染病例占56.6%(47/83),不明原因发热病例占34.9%(29/83)。常见感染部位咽、口腔和舌体病例占28.9%(24/83),胃肠道病例占24.1%(20/83)。主要病原菌为革兰阴性菌42.9%,经验性抗生素治疗有效率为100.0%。结论:高危和复发转移性乳腺癌大剂量化疗后具有极高的粒细胞缺乏症和发热的发病率,多于1周内出现,持续3～4 d。消化道是其常见感染部位,以革兰阴性菌为主。综合性防治措施有效。
Objective: To investigate the incidence, infection, pathogens and treatment of agranulocytosis after high-dose chemotherapy in high-risk and recurrent metastatic breast cancer. Methods: A total of 145 high-dose chemotherapy cases of high-risk and recurrent breast cancer in our department were collected from July 2004 to April 2009 with clinical data. Results: The incidence of agranulocytosis after high-dose chemotherapy in high-risk and recurrent breast cancer was 97.2% (141/145). The incidence of fever was 57.2% (83/145) and continued (3.37 ± 1.77) d. The median minimum number of neutrophils in fever group and non-fever group was 0.000 × 109L-1 and 0.026 × 109L-1, respectively, χ2 = 4.563, P = 0.033. The mean neutropenia duration was 4.75 and 3.26 days respectively, t = 4.409, P = 0.000. Microbiologically confirmed infections accounted for 8.4% (7/83), clinically diagnosed infections 56.6% (47/83), and unexplained fever 34.9% (29/83). Commonly infected parts of the pharynx, mouth and tongue cases accounted for 28.9% (24/83), gastrointestinal cases accounted for 24.1% (20/83). The main pathogens are gram-negative bacteria 42.9%, the empirical antibiotic treatment efficiency was 100.0%. CONCLUSIONS: The incidence of high-grade agranulocytosis and fever after high-dose chemotherapy in high-risk and recurrent metastatic breast cancer occurs more than 1 week for up to 3 to 4 days. Gastrointestinal tract is the common site of infection, mainly gram-negative bacteria. Comprehensive prevention and control measures effective.