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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 investigate the influencing factors of invasive fungal infection (IFI) in hematologic malignancies and the changes of intestinal microflora before and after fungal infection, and to provide evidence for the diagnosis and treatment of invasive fungal infection of hematologic malignancies. Methods One thousand patients with hematologic malignancies were selected from January 2010 to December 2015 in our hospital. Among them, 164 cases of IFI were selected as the observation group and 164 cases of healthy controls were selected as the control group. Univariate and multivariate logistic analysis (IFI) Influential factors and detection of intestinal flora by PCR method. Results The incidence of IFI in patients with acute leukemia and myelodysplastic syndromes, underlying diseases, application of glucocorticoid, application of antibacterials for more than 7 days and antibacterials> 2 and leucocyte count ≤1.0 × 109 / L was higher than that of lymphoma + Chronic leukemia + multiple myeloma, no underlying disease, no glucocorticoids, antibacterial drug application time ≤7d, antibacterial drug species ≤2, leukocyte count> 1.0 × 109 / L (P <0.05) Corticosteroids and antimicrobial agents> 2, the white blood cell count≤1.0 × 109 / L was an independent risk factor for IFI (P <0.05); the level of peripheral blood lymphocytes, leukocytes and neutrophils ± 0.67,7.46 ± 2.14,0.27 ± 0.03) × 109 / L were significantly lower than those before infection (9.02 ± 1.04,38.24 ± 11.43,3.52 ± 0.86) × 109 / L (P <0.05) (P <0.05). The bacterial counts in the observation group before and during infection were significantly lower than those in the control group (P <0.05). The number of fungi in the observation group was higher than that before infection (P <0.05) ). The bacterial counts in observation group were lower than those before infection (P <0.05). CONCLUSIONS: Glucocorticoid and antibacterial drugs are more than two kinds. The white blood cell count ≤1.0 × 109 / L is an independent risk factor for invasive fungal infection of hematologic malignancies. Invasive fungal infection of malignant hematological diseases and intestinal fungal quantity increase. Reduce the relevant.