恶性血液病的医院感染

目的：探讨恶性血液病（ＨＭ）院内感染（ＮＩ）的危险因素，临床意义和治疗。方法：回顾１５３例ＨＭ的ＮＩ，比较粒缺组与非粒缺组的医院感染率（ＮＩＲ）、死亡率、院内感染持续时间、感染部位。２０例曾用泰能治疗。３１例患者化疗后２ｄ￣１４ｄ外周血ＷＢＣ〈２．０×１０＾９／Ｌ时给用Ｇ－ＣＳＦ，剂量为７５￣１５０ｍｇ／ｄ。８例严重ＮＩ患者使用静脉免疫球蛋白（ＩＶＩｇ）治疗。结果：ＮＩＲ为５２．９％，粒缺组与非粒     

实体肿瘤化疗患者使用粒细胞集落刺激因子对外周血中性粒细胞形态参数变化的影响

目的比较实体肿瘤化疗患者使用粒细胞集落刺激因子(G-CSF)前后外周血中性粒细胞侧向散射光强度即颗粒度(neutrophil lateral scattering intensity,NEUT-X)的变化并探讨其临床意义。方法选取52例肿瘤化疗使用G-CSF患者(研究组),32例肿瘤化疗未使用G-CSF患者(研究对照组)和50例门诊表观健康查体者(健康对照组),使用Sysmex XE-2100全自动血细胞分析仪检测研究对象的外周血细胞计数,收集外周血白细胞形态参数结果数据。分析研究NEUTX参数在化疗过程中的变化,同时观察三组患者临床感染发热率,以揭示白细胞形态参数与机体抵抗能力的关系。结果研究组、研究对照组和健康对照组外周血中性粒细胞NEUT-X为:1 324(890.2,1 358.0),1 440(1 397.3,1 466.3),1 329(1 295.1,1 359.4),三组之间差异具有统计学意义(F=10.778,P=0.002),且两两比较差异具有统计学意义;研究组患者使用G-CSF前后白细胞数分别为:0.99(0.22,1.75)×109/L,7.53(1.00,14.05)×109/L,两者之间差异具有统计学意义(Z=-2.395,P=0.005);研究组患者使用G-CSF前后中性粒细胞形态参数NEUT-X分别为:1 382(1 323.6,1 440.4),1324(890.2,1 358.0),两者之间差异具有统计学意义(Z=-2.832,P=0.004);研究组与研究对照组患者感染发热病例数分别为:23/52例、4/32例(χ~2=9.14,P=0.002)。结论肿瘤化疗病人使用G-CSF外周血白细胞数升高,中性粒细胞NEUT-X参数降低,且感染发热率高于未使用G-CSF患者,推测中性粒细胞颗粒度对评估实体肿瘤化疗病人免疫力具有一定的价值。     

恶性肿瘤24例化疗后Ⅳ度骨髓抑制的治疗观察

目的:探讨化疗后IV度骨髓抑制患者的治疗方法.方法:对于化疗后外周血白细胞《1.0×109/L的病人采取保护性隔离,应用粒细胞集落刺激因子(G-CSF)、抗生素、支持治疗等直至外周血白细胞》4.0×109/L,当出现感染性发热时可使用三代头孢类抗生素或泰能控制感染,同时细心观察病人口腔及大便,注意有无霉菌感染.结果:24例病人骨髓造血功能均在7～10 d内恢复正常.无严重合并症及致死病例. 结论:采取以G-CSF为主,辅以支持治疗,抗感染等综合治疗,可以使患者安全、快速地度过骨髓抑制期的危险阶段.     

克拉屈滨持续静脉滴注组成的CLAG方案治疗难治/复发性急性髓系白血病的临床分析

目的:研究克拉屈滨(2-CdA)持续静脉滴注联合大剂量阿糖胞苷(Ara-C)及粒细胞集落刺激因子(G-CSF)2019年8月在郑州大学附属肿瘤医院血液科等5家医疗单位住院且采用1个疗程CLAG方案(具体为:克拉屈滨5mg/m²,d 1-5,持续24 h静脉滴注;Ara-C 2 g/m²,1/d,d 1-5,静脉滴注;G-CSF 300 mg,1/d,d 0-5,皮下注射)治疗的岁;FAB分型:M₁1例,M₂a 3例,M₂b 4例(其中1例伴髓外侵犯),M₄1例伴髓外侵犯,M₅5例,HAL 1例;NCCN分型:中危组6例,高危组9例;难治8例,复发7例。前期中位化疗次数4(2-8)个(其中例15曾接受化疗8周期,并12例(12/15,80%),CR中位持续时间为65(0-528)d。所有患者化疗后均出现IV级白细胞减少及血小板减少,粒缺期中位持续时间为20(14-33)d,治疗相关死亡1例。7例患者接受异基因造血干细胞移植。15例患者的中位无事件复发/难治性AML,CR高,但CR持续时间短,骨髓抑制重。因此,控制感染是关键,CR后应尽早行异基因造血干细胞移植术。     

急性淋巴细胞白血病患者化疗后感染发生危险因素及预防对策

目的：探讨急性淋巴细胞白血病患者化疗后感染发生危险因素及预防对策。方法以2014年1月至2015年11月在该院治疗的93例急性淋巴细胞白血病患者的临床资料为研究对象,以是否发生院内感染为标准将其分为感染组（50例）和未感染组（43例）;并对两组患者基本资料、生化指标、化疗强度等因素进行单因素和多因素Logistic回归分析。结果本组患者感染率为53．8％;其中上感及肺部感染分别占38．2％和16．8％;病原菌检测发现院内感染多为革兰氏菌,阳性检测率30％;单因素分析显示年龄、住院时间、血红蛋白、白细胞计数、清蛋白、抗生素使用种类及时间、化疗强度、中性粒细胞与院内感染关系密切,而多因素Logistic回归分析发现,清蛋白、抗菌药物使用时间、化疗强度和中性粒细胞为独立危险因素。结论急性淋巴细胞白血病患者化疗后清蛋白及中性粒细胞下降、使用抗菌药物时间过长及化疗强度是影响院内感染的危险因素,因此临床应合理使用抗菌药物,有针对性地采取预防措施降低院内感染率。     

巨和粒联合惠尔血对急性非淋巴细胞白血病患者化疗后血象的影响

目的:观察重组人白细胞介素11(IL-11,巨和粒)及重组人粒细胞集落刺激因子(G-CSF,惠尔血)联合应用对初治急性非淋巴细胞白血病患者化疗后血小板、白细胞的影响。方法:观察31例初治急性非淋巴细胞白血病患者化疗后应用巨和粒及/或惠尔血后血小板、白细胞的恢复情况,化疗结束后24 h开始皮下注射巨和粒25~50μg/(kg.d),连用10~14 d,惠尔血5μg/(kg.d),连用10~14 d,PLT>50 g/L,停用巨和粒;G>1.5 g/L停用惠尔血。结果:IL-11可明显升高化疗后血小板最低值,减少输血次数;IL-11及G-CSF联合应用对化疗后白细胞的恢复时间与单用G-CSF相近。结论:IL-11能有效提升急性非淋巴细胞白血病患者化疗后的血小板,与G-CSF的联合应用能降低病人化疗后骨髓抑制的早期病死率。     

急性白血病院内感染易感因素分析

为探讨急性白血病发生院内感染的易感因素。采用回顾调查方法对１６２例次院内感染进行分析。结果：急性白血病院内感染率为住院次数的６１．６％,感染部位以呼吸道、口腔、皮肤软组织、败血症为主;感染细菌主要为Ｇ＾－杆菌、真菌;院内感染与化疗、白细胞计数、环境的消毒隔离以及抗生素应用密切相关。结论：为了减少院内感染的发生率和病死率,除选择最佳方案治疗白血病本身外,应对其化疗后的粒细胞缺乏期给予良好的支持治疗,     

难治性急性髓系白血病诱导化疗前两天应用G-CSF的双盲对照研究

粒细胞集落刺激因子(G-CSF)对强烈化疗和骨髓移植后的中性粒细胞缺乏症极为有用,可加速中性粒细胞数恢复。但G-CSF应用于髓系白血病,目前尚有争论。在体外试验中,G-CSF不但刺激正常粒系祖细胞,还刺激髓系白血病细胞。 本文对58例复发或难治住AML患者进行了多中心的、随机双盲对照研究,以评价;①G-CSF在强烈诱导缓解治疗后促使造血功能重建的作用;②应用G-CSF2天后骨髓中白血病细胞生长的变化;③诱导治疗后,G-CSF对白血病细胞再生长的作用,④在应用G-CSF后5周内,G-CSF对感染发生的作用。     

化疗后粒细胞缺乏伴发热白血病儿超敏C反应蛋白血清水平的临床意义

目的:为探讨白血病患儿化疗后中性粒细胞缺乏(粒缺)伴发热时超敏C反应蛋白(hs-CRP)血清水平的临床意义。方法:分析我院2004年10月～2007年12月的白血病患儿化疗后粒缺不伴发热者(A组),粒缺伴发热者(B组)及粒缺发热伴败血症者(C组)的hs-CRP血清水平。结果:A组(不发热组)hs-CRP血清水平为(5.37±4.65)mg/L,B组(发热组)为(74.05±48.35)mg/L,C组(败血症组)为(122.00±66.32)mg/L。A组与B组、C组比较有显著差异性(P<0.01)。结论:hs-CRP血清水平可作为儿童白血病化疗后中性粒细胞缺乏合并细菌感染的监测指标,对儿童白血病化疗后粒缺发热伴败血症的早期治疗有一定的临床指导意义。     

急性髓系白血病化疗发生院内感染的危险因素分析

目的分析急性髓系白血病(AML)化疗发生院内感染的危险因素。方法回顾性分析我院收治的260例AML患者的临床资料,分析影响AML患者化疗发生院内感染的危险因素。结果 260例AML患者共接受化疗584例次,168例患者发生院内感染,累计发生感染372例次,院内感染率为64.62%,院内例次感染率为63.70%,感染发生部位主要为呼吸道、口腔、血液等; 168例院内感染患者样本检出109例阳性,阳性率为64.88%,获得病原菌75株,其中革兰氏阴性菌(G~-)占41.33%(31/75),革兰氏阳性菌(G~+)占32.00%(24/75),真菌占14.67%(11/75),其他病原菌占12.00%(9/75)。院内感染和未感染患者年龄、住院时间、接受糖皮质激素治疗、化疗强度、骨髓抑制程度、白细胞数、中性粒细胞缺乏持续时间、血红蛋白含量比较,差异有统计学意义(P0.05)。患者年龄≥50岁、住院时间≥4周、高化疗强度、严重骨髓抑制、中性粒细胞缺乏持续时间7 d是其相关危险因素。结论 AML患者化疗发生院内感染率较高,主要以呼吸道、口腔、血液感染最为多见,病原菌以G~-为主,高龄、一个月及以上住院时间、高化疗强度、严重骨髓抑制、中性粒细胞缺乏持续时间一周以上是影响AML患者化疗发生院内感染的相关危险因素。     

Haematopoietic growth factor in antithyroid-drug-induced agranulocytosis

Drug-induced agranulocytosis (DIA) is often caused by antithyroid drugs. We retrospectively studied the use of granulocyte colony-stimulating factor (G-CSF) therapy in antithyroid-DIA. Data for 20 patients (10 treated with G-CSF) with antithyroid-DIA (neutrophil count <0.5x10(9)/l) were extracted from a cohort study of DIA patients (n=110). G-CSF (300 microg/day subcutaneously) was used where the neutrophil count was <0.1x10(9)/l, or the patient was aged >70 years, or there were severe features of infection or underlying disease. Mean patient age was 62 years (range 34-87); sex ratio (M/F) was 0.05. Carbimazole (n=19) and benzylthiouracile (n=1) were the causative drugs, at mean doses of 30 mg/day (range 20-60) and 100 mg/day (range 50-150), respectively, for a mean of 37 days (range 31-90). Antithyroid drugs were prescribed for Graves' disease (n=8), thyrotoxicosis related to amiodarone intake (n=6) and multinodular goitre (n=6). Clinical features included isolated fever (n=7), pneumonia (n=5), septicaemia or septic shock (n=5) and acute tonsillitis (n=3). Mean neutrophil count was 0.07+/-0.1x10(9)/l. No patient died. Mean durations of haematological recovery, antibiotic therapy and hospitalization were significantly reduced with G-CSF: 6.8+/-4 days vs. 11.6+/-5; 7.5+/-3.8 days vs. 12+/-4.5; and 7.3+/-4.8 days vs. 13+/-6.1, respectively (all p<0.05). G-CSF induced flu-like symptoms in 30% of patients, but reduced overall costs.     

Treatment of idiopathic thrombocytopenic purpura in adults: efficacy of domestic intravenous immunoglobulin in immune thrombocytopenia]

AIM: The study of effectiveness of intravenous immunoglobulin (IVIG) in therapy of idiopathic thrombocytopenic purpura (ITP) in adults. MATERIALS AND METHODS: High doses of IVIG (0.2-0.4 g/kg b.w. for 4-6 days) were given to 6 female patients aged 20 to 59 years (median--39 years) with immune thrombocytopenia. 4 patients had primary ITP resistant to glucocorticosteroids (GCS) and 1 female had chronic ITP treated by splenectomy without effect. 1 patient with rheumatoid arthritis developed severe thrombocytopenia combined with agranulocytosis when treated with nonsteroid antiinflammatory drugs. RESULTS: The response was observed in 5 of 6 patients (in 4 patients resistant to GCS and 1 RA patient). In 3 of them the effect was rated as excellent (platelets level > 150,000 per cubic millimeter), in 2 patients it was good (platelets count from 50,000 to 150,000 per cubic millimeter). Splenectomy was performed in 4 cases with ITP on day 8-14 after IVIG therapy. The 2- and 6-month follow-up evidenced for good results of the surgical treatment. The RA patient showed a stable rise of the blood count. Serious side effects of IVIG therapy were not registered. CONCLUSION: IVIG of Russian produce is effective in the treatment of drug-induced thrombocytopenia and ITP resistant to GCS.     

抗甲状腺药物致粒细胞缺乏症17例临床分析

目的　探讨抗甲状腺药物 (ATD)引起粒细胞缺乏症的临床特点 ,治疗及转归。方法　对 17例因服用ATD致粒细胞缺乏症患者进行回顾性分析。结果　单独应用糖皮质激素氢化可的松 (HCSS)和联合应用重组人粒细胞集落刺激因子 (G CSF)均有效 ,有效率达 10 0 % ,但HCSS与G CSF联合应用效果更明显 ,粒细胞恢复正常时间更短。 17例患者中 ,82 9%的粒细胞缺乏症发生在ATD治疗后的 2个月以内。结论　对服用ATD者均应常规监测外周血白细胞 ,尤其在开始治疗的前 2个月 ,以尽早发现 ,及时治疗。HCSS和G CSF治疗ATD所致粒细胞缺乏症疗效肯定 ,但对重症病例 ,应用HCSS与G CSF联合治疗优于单独应用HCSS治疗 ,若合并感染 ,应加用抗生素。     

Central venous catheter infections in patients with acute leukemia

BACKGROUND: Central venous catheters (CVCs) have become an essential tool for an appropriate management of patients with acute leukemia. Infectious complications are a major concern in patients treated for acute leukemia. Although CVC-related infections are considered to be a major source of infections during neutropenia (<500/microl), data regarding the incidence of CVC-related infections are rare in acute leukemia. PATIENTS AND METHODS: We analyzed nontunneled CVCs in 58 patients with acute leukemia (22 men/36 women) in 119 chemotherapy cycles from April 1996 to January 1998 in a prospective trial. Proven CVC-related infection was defined as the isolation of the same organism from peripheral blood and CVC tip. CVC infection was suspected or possible when exit site inflammation and positive blood culture or organisms typical for CVC infection were observed. RESULTS: Mean neutropenia/cycle was 16.3 days (SD 8.0). 178 CVCs with 2,576 CVC days (mean 14.5 days, SD 7.2 days) were used in 119 cycles. Fever occurred in 87 cycles (73%). Blood stream infection was proven in 31 out of 87 febrile episodes (26.1%) with 40 isolates (8 gram-negative, 31 gram-positive, 1 Candida spp.). Colonization of the CVC tip was observed in 24 CVC lines with 28 isolates (27 gram-positive, 1 gram-negative); however, proven CVC-related infections were observed in 5 episodes only, all with coagulase-negative staphylococci. In another 6 episodes, CVC-related infection was assumed (local inflammation and gram-positive blood culture). Six further episodes had typical blood isolates (4 coagulase-negative staphylococci, 1 Candida spp.) and were considered possible CVC-related infections. In none of the remaining afebrile 32 cycles was a CVC infection observed or suspected. CONCLUSION: Gram-positive organisms contributed to the majority of CVC-related infections (16 out 17 CVC infections); however, the overall incidence of CVC infections in acute leukemia patients was 6.5/1,000 CVC days only (1.9 proven/2.3 suspected/2.3 possible/1,000 CVC days).     

Granulocyte-colony stimulating factor for the prevention of chemotherapy-induced febrile neutropenia in the adult cancer patient population of Southern Israel

 To evaluate the efficacy of granulocyte-colony stimulating factor (G-CSF) prophylaxis in preventing chemotherapy-induced febrile neutropenia in the heterogeneous population of adult cancer patients treated in our institution, all adult cancer patients with either a solid tumor or lymphoma who were admitted for chemotherapy in our institution between 1 January 1994 and 31 July 1995 were retrospectively studied. We compared the characteristics of chemotherapy cycles in which G-CSF was given as prophylaxis and of those with no prophylaxis. In all, 1,079 chemotherapy cycles given to 209 patients were analyzed. Prophylaxis with G-CSF was given in 66 cycles (6%). Patients receiving G-CSF were significantly younger and were more likely to have lymphomas. Febrile neutropenia developed in 40 cycles (4%). There was no difference in the rates of febrile neutropenia, infection, hospitalization or mortality between the study groups in general, and cycles administered to patients being treated for lymphomas in particular. The routine use of prophylactic G-CSF in a mixed cancer patient population with a low incidence of febrile neutropenia is not justified and should be reserved for individual patients with a high likelihood of developing febrile neutropenia.     

Monoclonal immunoradiometric assay and polyclonal radioimmunoassay compared for measuring neuron-specific enolase in patients with lung cancer.

Neuron-specific enolase (NSE) is the most sensitive and specific tumor marker for small-cell lung cancer (SCLC). We evaluated a new monoclonal IRMA (Sangtec) for NSE and compared it with a polyclonal RIA (Pharmacia) in patients with SCLC or other lung cancers (NSCLC). We measured NSE concentrations in 100 healthy subjects (NI group), 100 patients with benign pulmonary diseases (BPD group), and 194 patients with advanced lung cancer (97 SCLC and 97 NSCLC). Intra- and interassay CVs were less than 7% for both assays, and dose-dilution curves paralleled their respective standard curves. Values measured by both assays were highly correlated in all groups. NSE concentrations were significantly (P less than 0.001) lower by IRMA than by RIA in NI and BPD groups. The upper 95th percentile values for NSE in the NI group were 11.7 micrograms/L in the RIA and 9.2 micrograms/L in the IRMA. In NSCLC, the values were significantly (P less than 0.05) lower by IRMA but the percentage of subjects with increased values was higher (vs the NI group, 31% for RIA and 44% for IRMA, P less than 0.005). Diagnostic sensitivity for SCLC was improved with IRMA: 83% of values with RIA and 93% with IRMA were increased above the NI group values (P less than 0.005); the corresponding values for SCLC vs BPD were 81% and 89% (P less than 0.05). NSE values measured in 39 patients with SCLC after chemotherapy were more often increased and were significantly higher with the IRMA than with the RIA (P less than 0.005).     

急性脑血管病患者医院感染分析及对策

目的：探讨急性脑血管病与医院感染的关系。方法：对654例急性脑血管病患者进行医院感染多因素分析。结果：医院感染率为15．14％，呼吸道感染占首位，分离菌株以G^-杆菌及真菌为主。医院感染率与糖尿病、住院天数及病情严重程度密切相关。结论：加强护理管理，提高医护人员对医院感染的防范意识，积极预防脑血管病合并症及并发症的发生，缩短住院天数，避免侵袭性操作，促进排痰及合理使用抗生素，不断完善各项监控措施，对控制医院感染、降低医院感染率至关重要。     

Comparison of the approaches to non-febrile neutropenia developing in children with acute lymphoblastic leukemia

The objectives of this study was to investigate of the influences of high-dose (20 mg/kg/day) methyl prednisolone (HDMP) and granulocyte colony stimulating factor (G-CSF) in shortening the duration of chemotherapy-induced neutropenia encountered in children with ALL receiving maintenance therapy. Sixty-four non-febrile neutropenic attacks developed in 29 patients with ALL receiving St Jude XIII maintenance protocol were evaluated retrospectively. The patients were clinically followed up without drugs for shortening the duration of neutropenia in 21 (32.8%) attacs, while HDMP and G-CSF were administered in 26 (40.6%) and 17 (26.6%) attacks, respectively. After the detection of neutropenia, restoration of neutrophil counts at 2nd or 4th days to the levels that allow resuming the chemotherapy were considered as success. While second day and overall success rates in patients administered HDMP and G-CSF were significantly higher than the patients who were observed clinically. Both second day and overall neutrophil counts were significantly higher in patients administered G-CSF than the other groups. Methyl prednisolone and G-CSF treatments were well-tolerated by the patients. The cost-per neutropenic attack was significantly higher in G-CSF group than of the HDMP group. Especially in patients experiencing frequent neutropenic attacks and hence interruptions of the therapy, one of the myelopoiesis induction therapies can be used to shorten the duration of neutropenia. For this indication short-course HDMP therapy can be considered as an alternative to G-CSF in this patients due to its relatively low cost, amenability to outpatient administration, and well-tolerability by children.     

Prospective study of empiric monotherapy with ceftazidime for low-risk grade IV febrile neutropenia after cytotoxic chemotherapy in cancer patients

PURPOSE: It was the aim of this study to evaluate the results of a prospective study in a single medical center using ceftazidime monotherapy in cancer patients with chemotherapy-induced grade IV febrile neutropenia and a low risk for gram-negative bacteremia. SUBJECTS AND METHODS: Thirty-eight patients were admitted with low-risk grade IV febrile neutropenia after chemotherapy for solid tumors. The median patient age was 57 years (range 18-74). Sixteen patients (42%) developed febrile neutropenia after the first cycle of current chemotherapy line, 9 patients (24%) received 2-3 cycles and 13 patients (34%) received more than 3 chemotherapy cycles before manifesting febrile neutropenia. Five patients were treated with prophylactic granulocyte colony-stimulating factor commenced 24 h after completion of the chemotherapy cycle. Empiric monotherapy with intravenous ceftazidime was started on admission and administered 2 g every 8 h. RESULTS: The mean polymorphic nuclear cell count on admission was 231 cells/mm(3). Ceftazidime therapy was well tolerated. Twenty-five (66%) patients responded with clinical improvement and complete resolution of fever within 48 h after initiation of ceftazidime therapy. Thirty-two (84%) patients were afebrile after 72 h of therapy. Thirty-three patients (87%) remained on unmodified ceftazidime therapy throughout their hospitalization. Five patients (13%) subsequently required modification of the treatment regimen for various reasons. Mean duration of fever and neutropenia were 2 (1-10) days and 4 (1-11) days, respectively. None of the patients discontinued therapy because of adverse effects. No positive blood cultures were obtained. No events of septic shock were observed. Mean duration of hospitalization was 6 days (range 3-12). CONCLUSION: In our series, monotherapy with intravenous ceftazidime appears safe and effective in cancer patients with low-risk grade IV febrile neutropenia after cytotoxic chemotherapy and may appreciably reduce antibiotics costs.     

抗甲状腺药物致粒细胞缺乏症46例临床分析

目的:探讨抗甲状腺药物(ATD)引起粒细胞缺乏症的病因、临床特点、诊治方法。方法:对我院收治的46例因服用ATD致粒细胞缺乏症患者的临床资料进行回顾性分析。结果:粒细胞缺乏症多数发生在服药后2~8周。他巴唑(MMI)组的发病时间及粒细胞值较丙基硫氧嘧啶(PTU)组之间无统计学意义(P>0.05)。多数病例有咽痛、发热等临床症状。所有患者停用ATD,选择性使用升白细胞药、糖皮质激素、粒细胞集落刺激因子(G-CSF),症状均好转。结论:对服用ATD者均应常规监测外周血白细胞,尤其在开始治疗的前2个月,以便尽早发现,及时治疗。重症病例应加用G-CSF。