多发性骨髓瘤患者使用硼替佐米化疗期间发生肺部感染的临床危险因素分析

目的:探索以硼替佐米化疗的多发性骨髓瘤(MM)患者肺部感染的危险因素、病原菌株的分布及其耐药性。方法:选取2015年1月至2019年1月于甘肃省人民医院接受治疗的85例采用以硼替佐米为主化疗方案治疗的初治MM患者临床资料,依据是否发生肺部感染分为感染组和对照组,并对其发生肺部感染的危险因素、病原菌分类及耐药性进行回顾性分析。结果:85例MM患者肺部感染率55.29%。感染组中性粒细胞减少、贫血、ECOG评分≥2分比例显著高于对照组患者,数据对比具有统计学差异(P<0.05)。本研究累计检测出30株病原菌,革兰阴性菌60%,革兰阳性菌占33.33%,真菌占3.3%,结核菌占3.3%。铜绿假单胞菌、肺炎克雷伯菌、肺炎链球菌、金黄色葡萄球菌所占比例最高。MM患者合并肺部感染经过2周抗生素治疗,大部分患者预后较好,但肺部感染所致的死亡人数为3人,约占MM患者早期死亡人数的30%,其是MM患者早期重要的死亡原因。结论:中性粒细胞减少、贫血、ECOG评分≥2分是使用硼替佐米为主化疗方案的MM患者发生肺部感染的独立危险因素,同时肺部感染也是MM患者早期死亡主要原因。未获得培养结果及药敏结果前暂可经验性使用β内酰胺类和酶抑制剂复合制剂及碳青霉烯类抗生素控制感染。

Analysis on Related Factors of Pulmonary Infection in Patients with Multiple Myeloma Treated with Bortezomib

Objective;To analyze the risk factors,distribution of pathogenic strains and tolerance of pulmonary infection in patients with multiple myeloma(MM)during bortezomib chemotherapy.Methods;The clinical data of 85 patients with multiple myeloma treated by bortezomib in our hospital from January 2015 to January 2019 was analyzed.The patients were divided into infection group and control group according to whether they were infected.The tolerance,pathogen distribution,and related risk factors were retrospectively analyzed.Results;Pulmonary infection rate was 55.29%in 85 MM patients.The proportions of the patients with anemia,neutropenia,and ECOG score≥2 points in the infection group were significantly higher than those in the control group(P<0.05).In this study,30 strains of pathogenic bacteria were detected,with gram-negative bacteria accounting for 60%,gram-positive bacteria for 33.33%,fungi for 3.3%and tuberculosis bacteria for 3.3%.Pseudomonas aeruginosa,klebsiella pneumoniae,streptococcus pneumoniae,staphylococcus aureus accounted showed the highest proportion.Most of MM patients with pulmonary infection showed a heterprognosis after two weeks antibiotic treatment,while 3 patients died.About 30 percent of early deaths were due to pulmonary infections.Conclusion;Anemia,neutropenia,ECOG score≥2 points are the major clinical characteristics of the multiple myeloma patients with pulmonary infections.Pulmonary infection is an important cause of early death in patients with multiple myeloma.Pathogenic bacteria are mainly composed of gram-negative bacteria.Beta-lacta/beta-lactamase inhibitor combinations or Carbapenems are effective empiric treatment for controlling the progression of pulmonary infection.