血液恶性肿瘤患者化疗后口腔感染的危险因素分析

目的探讨血液恶性肿瘤患者化疗后并发口腔感染的危险因素及防治对策,为临床预防口腔感染提供参考。方法选取2011年2月-2013年10月收治的224例血液恶性肿瘤接受化疗患者为研究对象,给予前瞻性研究,对化疗后发生口腔感染的可能危险因素进行单因素χ2检验以及多因素非条件logistic回归分析。结果224例化疗患者中有42例发生口腔感染,感染率18.8%,口腔感染的主要部位为颊部、牙龈,分别占38.1%、23.8%;经多因素logistic回归分析最终筛选出年龄、血清白蛋白水平<40g/L、粒细胞绝对值<0.5×109/L、口腔环境与口腔自洁习惯差、多次化疗周期、化疗未缓解是血液恶性肿瘤患者化疗后并发口腔感染的高危因素。结论血液恶性肿瘤患者因多种因素导致化疗后口腔感染的发生,应当积极的加强感染控制措施,对各种危险因素进行积极干预以降低口腔感染率。     

血液肿瘤患者感染病原菌分布与耐药性研究

目的探讨血液肿瘤患者感染病原菌的分布及耐药性,为选择合适的抗菌药物提供依据。方法回顾性分析2009年7月-2012年7月医院1 249例血液肿瘤患者临床资料,对其血液样本的采集、培养的病原菌进行鉴定,并分析其病原菌的分布及耐药性。结果 1 249例患者血培养标本分离出病原菌127株,其中革兰阴性菌89株占66.9%,以大肠埃希菌34株26.8%、铜绿假单胞菌16株12.6%、肺炎克雷伯菌15株11.8%为主,革兰阳性菌36株占28.3%,以表皮葡萄球菌11株8.7%、金黄色葡萄球菌8株6.3%、屎肠球菌6株4.7%为主,真菌7株占4.8%,以热带假丝酵母菌4株3.2%为主;大肠埃希菌对亚胺培南的耐药率为100.0%,铜绿假单胞菌对阿米卡星的耐药率为93.8%,肺炎克雷伯菌对亚胺培南的耐药率为100.0%,表皮葡萄球菌、金黄色葡萄球菌对利奈唑胺、万古霉素、喹奴普汀/达福普汀的耐药率均为100.0%。结论血液肿瘤患者感染的病原菌种类较多、耐药率较高,做好病原菌耐药性及时监测和抗菌药物的正确选择,对控制血液感染起着非常重要的影响。     

伊曲康唑对恶性血液病患者侵袭性真菌感染的疗效分析

目的 研究伊曲康唑在治疗恶性血液病患者侵袭性真菌感染的临床疗效.方法 将医院2009年5月-2011年12月收治的96例恶性血液病患者纳入研究,对于符合真菌感染拟诊病例纳入序贯治疗组(45例),符合真菌感染经验性治疗的病例纳入经验治疗组(51例),经验治疗组采用伊曲康唑静脉给药,以患者体温恢复正常为有效,序贯治疗组采用伊曲康唑序贯治疗方案,该组患者以临床症状消失为有效;治疗过程中经验治疗组有患者符合拟诊或确诊标准时,则转入序贯治疗组进行治疗,一个疗程后对两组患者进行疗效评估.结果 经验治疗组的51例患者中,有9例转为拟诊病例,进行疗效评估时共有42例患者,其中有效者38例,有效率为90.48％;序贯治疗组在进行疗效评估时共有拟诊患者54例,有效51例,有效率为94.44％;所有患者中无肾功能损害发生,有4例肝功能出现异常.结论 伊曲康唑在治疗恶性血液病患者侵袭性真菌感染的中确实具有明显疗效,且安全性较好,值得在临床推广,但需注意使用过程中对肝功能的监测.     

恶性血液病患者医院感染肺部CT影像学特征及对预后的评估

目的探究恶性血液病患者医院感染的肺部CT表现及对预后的评估。方法选取2012年2月-2016年2月来本院诊治恶性血液病患者252例,将发生院内真菌感染(HFI)的70例为研究对象作为真菌组,广谱抗菌药物有效患者85例作为细菌组。分析患者病原菌的分布及变迁情况,研究患者发生真菌感染时的临床症状、体征、感染器官的影像学特征及其功能变化、抗真菌药的疗效。结果 252例恶性血液病患者,有70例发生HFI,感染率为27.78%,感染部位以呼吸道为主。肺部阳性发生率为35.71%;HFI患者肺CT表现磨玻璃密度影发生率为41.43%低于细菌组62.35%(P<0.05),同时,大结节直径>1cm、空洞、晕征、毛刺征、高密度团块影与新月征均出现在真菌组,而细菌组无出现,差异显著(P<0.05);单一用药有效率73.33%低于联合用药的75%,但差异无统计学意义,同时各联合用药间对比差异无统计学意义;在治疗过程中,发现真菌组肺CT表现加重率为21.43%显著高于细菌组5.88%(P<0.01)。结论对于恶性血液病患者医院感染,积极根据患者的肺部CT表现可以有效提高医院真菌感染诊断率,并改善预后情况。     

Surgical complications in hematological malignancies.

Surgical complications in oncohematological practice appear a primary problem for their high incidence, diagnostic and therapeutic difficulties and unfavourable prognosis. The authors present data from a retrospective study of 93 patients from the Clinic of Hematology and Surgical Clinic of the Higher Medical Institute in Plovdiv for the period from 1990 to 1997. Surgical complications occurred in 9.9% of the patients treated for hematological malignancies. Most frequent and hazardous were the cases of acute abdomen, followed by soft tissue purulent infections. The authors suggest that high risk of surgical complications exists in patients undergoing vigorous chemotherapy. Patients are particularly vulnerable in the neutropenic period after chemotherapy when the abdominal and anorectal complications may be fatal.     

伏立康唑治疗老年恶性血液病侵袭性真菌感染疗效分析

目的 探讨伏立康唑在老年恶性血液病侵袭性真菌感染患者中的临床疗效及不良反应.方法 对2007年5月-2011年12月的50例老年恶性血液病侵袭性真菌感染患者的临床资料进行回顾性分析.结果 确诊4例,临床诊断20例,拟诊26例;14例患者为初始治疗,36例患者为挽救治疗;总有效率为74.0％,确诊组4例均有效,临床诊断组有效率70.0％,拟诊组有效率73.1％;初始治疗有效率85.7％,挽救治疗有效率69.4％;经过静脉注射的患者有效率76.3％,单纯口服治疗有效率66.7％,两组差异无统计学意义;10例患者曲霉菌属感染,6例有效,曲霉菌属清除;粒细胞缺乏影响伏立康唑疗效,粒细胞缺乏组有效率58.4％,低于无粒细胞缺乏组的88.5％(P＜0.05);主要不良反应为肝功能异常、视觉障碍、幻觉,停药后可消失,未观察到肾毒性及心脏毒性. 结论 伏立康唑可安全有效地治疗老年恶性血液病侵袭性真菌感染.     

恶性血液病合并感染临床分析

目的探讨恶性血液病患者感染的发生、转归及病原菌分布。方法回顾性调查某院血液科2000年1月-2008年8月间980例恶性血液病住院患者发生细菌和真菌感染的情况。结果980例恶性血液病患者中,463例（47.24%）发生感染,其中社区感染者138例(29.81％),医院感染者325例(70.19％)。在医院感染病原体中,革兰阴性（G-）杆菌387株（55.68%）,革兰阳性（G+）球菌194株（27.91%）,真菌114株（16.40%）。最常见的感染部位为上呼吸道（35.06%）和下呼吸道（16.36%）。中性粒细胞的绝对计数越低,感染发生的概率越大（P＜0.05）;住院时间延长,感染率增高(P＜0.05)。结论恶性血液病患者感染率高,以医院感染为主;分离细菌以G-菌为主;患者中性粒细胞计数、住院时间与感染的发生相关。     

血液系统恶性肿瘤患者的生育力保存

随着肿瘤诊断和治疗方案的不断改进,癌症患者的生存率得到了显著提高。烷基化化疗和全身照射（total body irradiation, TBI）等性腺毒性抗癌方案经常用于治疗年轻的血液系统恶性肿瘤患者,这可能导致女性卵巢功能不全（premature ovarian insufficiency, POI）或男性生殖细胞大...     

恶性血液病患者血流感染病原菌特点及危险因素分析

目的了解恶性血液病患者血流感染病原菌分布及药物敏感性,探讨死亡危险因素,为临床早期诊断并有效治疗血流感染提供理论依据。方法回顾性分析2006年1月-2010年12月恶性血液病并发血流感染113例住院患者临床资料,统计病原菌种类、药物敏感性及临床特点;采用SPSS 17.0统计软件进行数据处理。结果分离到116株病原菌,其中革兰阴性菌57株占49.1%,革兰阳性菌51株占44.0%,真菌8株占6.9%;前3位病原菌为大肠埃希菌、人葡萄球菌、金黄色葡萄球菌,分别占25.0%、16.4%、7.8%;大肠埃希菌和肺炎克雷伯菌对美罗培南的敏感率均为100.0%;主要革兰阳性菌对万古霉素、替考拉宁、利奈唑胺的敏感率均为100.0%;发生血流感染<30d,死亡20例,病死率17.7%,多变量logistic回归分析表明,粒细胞缺乏时间>7d(P=0.006)、不正确的初始经验治疗(P=0.016)、年龄>65岁(P=0.031)是死亡危险因素。结论恶性血液病患者血流感染致病菌以革兰阴性菌为主,病原菌耐药问题日益严重,正确应用抗菌药物,缩短粒细胞缺乏时间,有效降低病死率。     

BIRCP联合常规检测在白血病患者化疗后骨髓抑制期感染的应用

目的通过对白血病患者化疗后骨髓抑制期患者感染前后细菌感染相关细胞因子谱(BIRCP)的检测,并结合C-反应蛋白(CRP)等常规检测方法,探讨BIRCP在感染性疾病中的应用价值。方法选取2014年1月-2017年1月于医院住院治疗的急性粒细胞白血病实行化疗后出现骨髓抑制的患者70例,将出现发热、咳嗽等感染症状的患者作为试验组,共60例,以试验组患者化疗前血清中BIRCP细胞因子水平作为基线水平。采用酶联免疫法(ELISA)测定感染发生24h内及感染控制24h后试验组患者的血清肿瘤坏死因子-α(TNF-α)、白细胞介素-2(IL-2)、IL-4、IL-6、IL-10、干扰素-γ(IFN-γ)等细胞因子的水平,并测定CRP和进行血培养,比较BIRCP和CRP的敏感性。并分析血培养阳性患者血清细胞因子的变化规律,进行感染原的判断。结果感染发生24h内6种细胞因子均出现不同程度的升高,其中IL-6、IL-10数值呈现明显的升高,与基线值相比,差异有统计学意义(P0.05)。感染控制24h后BIRCP中细胞因子水平均出现不同程度下降,其中TNF-α、IL-4、IL-6、IL-10、IFN-γ及CRP的感染前后变化较明显(P0.05)。在60例有感染症状的患者中,血培养阳性者20例。革兰阳性菌感染患者IL-6升高较明显(P0.05)。革兰阴性菌感染患者IL-6、IL-10升高较明显(P0.05)。而真菌感染患者的IFN-γ升高较明显,敏感度和特异性检测中发现IL-10对鉴别革兰阴性菌的敏感度可达80.10%,特异度可达78.20%。结论 BIRCP和CRP均能早期预测白血病患者化疗后骨髓抑制期感染情况,并通过BIRCP的检测可初步判断感染源,指导抗菌药物使用。     

Cord blood transplantation for adult patients with hematological malignancies

BACKGROUND: Recently, clinical studies of cord blood transplantation (CBT) in adults after myeloablative or nonmyeloablative conditioning regimens showed cord blood (CB) could effectively restore hematopoiesis and was associated with acceptable levels of graft versus host disease (GVHD). METHODS: This study reports the results of cord blood transplantation in 7 adults with hematological malignancies. RESULTS: Median age was 56 years (range, 43-69 years). HLA match was 4 of 6 in 4 cases and 5 of 6 in 3 cases. Median nucleated cell dose was 2.74 x 10(7) cells/kg (range, 2.13-3.80) and CD34+ cell dose was 1.15 x 10(5) cells/kg (range, 0.44-2.79). Three patients had primary graft failure. There was one early death at day 24 after CBT due to pneumonia. Three patients with engraftment are alive and free of disease at day 390, day 348 and day 164 after CBT. Acute GVHD grade II occurred in 2 cases with engraftment, and chronic GVHD occurred in 1 of 3 evaluable patients. Six patients with and without engraftment received more than 2.0 x 10(7) cells/kg nucleated cells. Three patients without engraftment received CD34+ cell dose less than that of 3 patients with engraftment. CONCLUSIONS: It is considered that graft CD34+ cell dose besides nucleated cell dose is important for engraftment. We believe that adult patients without suitable related or unrelated bone marrow donors should be considered as candidates for CBT by the choice of CB including both sufficient nucleated cell dose and CD34+ cell dose.     

恶性血液病患者感染调查研究

目的了解恶性血液病(HM)患者合并感染的临床特点。方法回顾性分析2004年住院接受化疗的327例HM患者的感染发生情况。结果感染发生率为33.64%;感染部位以呼吸道最多见,占40.85%;分离的病原菌主要是革兰阴性菌(43.33%)、革兰阳性菌(33.33%)和真菌(23.34%);急性白血病和各类复发的HM患者感染率最高,达70.58%;粒细胞缺乏与无粒细胞缺乏者感染率分别是69.39%和18.64%,两者差异有显著性(P<0.05)。结论HM患者感染率高,尤以急性白血病和各类复发的HM患者及粒细胞缺乏者为甚,应加强监控。     

Antifungal prophylaxis with low doses fluconazole in patients with hematological malignancies

INTRODUCTION: The incidence of mycotic infections in immunocompromised patients has reached a 20-fold rise for the last two decades. AIM: The goal of the study was to evaluate fluconazole efficacy as antifungal prophylaxis in patients with hematological malignancies. MATERIAL AND METHODS: Sixty nine patients with hematological malignancies and neutrophil count less than 1.0 x 10(9)/L received fluconazole orally at a dose of 150 mg every other day. Fluconazole was discontinued when a neutrophil count above 1.5 x 10(9)/L was maintained. Duration of neutropenic periods, afebrile cycles, and incidence of mycotic infections were assessed. The same variables were observed in a control group of 41 patients who did not receive antifungal prophylactic therapy. RESULTS: Both groups were similar in the mean duration of neutropenic period but the afebrile cycles in the patients receiving antifungal prophylaxis were longer by 5 days compared to these in the patients without prophylaxis. The mycotic infections had lower incidence in the patients on antifungal prophylaxis and the difference was statistically significant (p < 0.01). The superficial mycotic infections composed the majority of the clinically and/or microbiologically verified infections. These were presented by oropharyngeal infection (61%), esophageal (22%), and single cases of skin, genital or rectal infections. Candida albicans was isolated in 85% of the cases. The adverse reactions of fluconazole therapy were mild, transient, and easily manageable. No signs of liver and renal dysfunction were observed. CONCLUSION: Lower dose of fluconazole, 150 mg every other day p.o., has the same antifungal effect as a dose of 200 mg/day p.o. in neutropenic patients with hematological malignancies which lowers the cost of treatment.     

中医医院血液系统恶性肿瘤的病例组合研究

目的 探究适用于中医医院收治血液系统恶性肿瘤（hematological malignancies,HMs）患者的病例组合方案,为相关部门优化浙江省疾病诊断相关分组（diagnosis related group of zhejiang, ZJ - DRG）方案提供参考。方法 收集浙江省某三甲中医医院HMs患者的病案和医保反馈数据,采用线性回归分析和结构方程筛选分类节点,利用决策树模型进行HMs病例分组。结果 本研究中HMs病例组合的分类节点包括输血、化疗、并发症/合并症、骨髓移植、中医治疗和病理类型。1 075例HMs患者共形成8个DRGs组,方差减少量（reduction in variance, RIV）为55.17%,变异系数（coefficient of variation, CV）小于80.0%,组间异质性和组内同质性均达可接受标准。按ZJ - DRG,研究对象被分为21个DRGs组,组间异质性（RIV:30.33%）和组内同质性（CV:21.0%~112.0%）均一般。结论 对于中医医院收治HMs患者,现行ZJ - DRG分组方案还有待完善,可考虑增加输血、中医治疗等因素以提高DRG分组效果。     

伏立康唑和伊曲康唑治疗血液恶性肿瘤继发真菌感染的临床疗效及对血清炎症因子的作用

目的探究伏立康唑和伊曲康唑治疗血液恶性肿瘤继发真菌感染的临床疗效及对血清炎症因子的作用。方法选取2016年2月-2017年2月医院临床收治并确诊的血液恶性肿瘤继发真菌感染的病例126例作为研究对象,分为治疗组和对照组,每组63例,治疗组采用伏立康唑和伊曲康唑联合治疗,对照组采用伏立康唑治疗,观察两组患者治疗后的真菌清除情况;比较两组患者临床症状好转的时间;统计两组患者治疗的临床疗效;应用酶联免疫吸附(ELISA)的方法检测两组患者治疗前后血清中炎症因子含量的变化,包括肿瘤坏死因子-α(TNF-α)、白介素-4(IL-4)、白介素-10(IL-10)及白介素-12(IL-12);观察记录两组患者在治疗过程中出现的不良反应。结果治疗组患者检测出真菌67株,经过治疗后,58株菌株被消除,真菌清除率为86.57%;对照组患者检测出真菌68株,经过治疗后,42株菌株被消除,真菌清除率为61.76%(χ2=10.810,P=0.001);与对照组患者相比,治疗组患者高热、咳嗽、咳痰、恶心、感染性休克及呼吸衰竭好转的时间缩短(P0.01);经过治疗后,治疗组患者的治疗有效例数为56例(88.89%),高于对照组的治疗有效率(P0.05);与治疗前相比,两组患者血清中TNF-α和IL-12的含量均有下降(P0.01),且与对照组相比,治疗组患者血清中TNF-α和IL-12的含量更低(P0.01);与治疗前相比,两组患者血清中IL-4和IL-10的含量增加(P0.01),且与对照组相比,治疗组患者中IL-4和IL-10的含量更高(P0.01);治疗过程中,治疗组出现不良反应6例(9.52%),对照组出现不良反应7例(11.11%)。结论伏立康唑和伊曲康唑治疗血液恶性肿瘤继发真菌感染具有良好的临床效果,耐受性良好,且能够显著改善患者血清中炎症因子的失衡,值得临床推广。     

恶性血液病患者医院感染病原菌对血清炎性因子的影响研究

目的分析恶性血液病患者医院感染病原菌分布及对血清炎症反应的影响,为临床治疗提供参考依据。方法选择医院2009年3月-2014年3月2 800例恶性血液病患者进行研究,根据患者是否发生感染分为感染组与非感染组,选择同期健康体检者320名为对照组;采用法国生物梅里埃公司的API鉴定条及VITEK-2Compact全自动微生物鉴定系统和基因测序法对病原菌进行鉴定;分析感染患者病原菌的分布及其对血清炎症因子的影响,采用WHONE5.5软件和SPSS19.0软件对数据进行统计分析。结果 2 800例患者中发生医院感染172例,感染率为6.1%;分离出病原菌172株,其中革兰阳性菌70株占40.7%,革兰阴性菌102株占59.3%;感染患者血清中白细胞介素-1(IL-1)、IL-2、IL-6、IL-10明显升高,且肿瘤坏死因子α(TNFα)、超敏C-反应蛋白(hs-CRP)及转化生长因子β(TGFβ)蛋白水平均也明显升高,与对照组和非感染组患者比较,差异有统计学意义(P0.05)。结论恶性血液病患者容易发生医院感染,感染后能诱发明显的炎症反应。     

Qualitative findings on the experience of end-of-life care for hematological malignancies

There is a loud silence in the literature on the issues related to palliative care for hematological malignancies. This article presents information that begins to address that silence. The limited research that is available indicates that, to date, patients with a hematological malignancy and their families received scant attention with regards to the provision of palliative care. The findings presented in this article demonstrates that families are enduring considerable hardship and are left with much emotional pain and many unresolved issues when such care is not offered. It is hoped that the findings presented in this article will be used for developing effective strategies to ensure that patients with hematological malignancies and their families, no less than any others, can be afforded the dignity and respect that the appropriate provision of palliative services ensures.     

以盆腔包块为主要症状的血液恶性肿瘤3例

<正>1主持人吉林大学第二医院妇产科张立会主任医师2病例汇报人吉林大学第二医院妇产科吴飞副主任医师3病历摘要病例1:女,39岁,G_2P_1,因检查发现盆腔肿物12d入我院。20 d前自觉尿频,并触及下腹部包块。病程     

Allergic conditions and risk of hematological malignancies in adults: a cohort study

Background

Two contradictory hypotheses have been proposed to explain the relationship between allergic conditions and malignancies, the immune surveillance hypothesis and the antigenic stimulation hypothesis. The former advocates that allergic conditions may be protective against development of cancer, whereas the latter proposes an increased risk. This relationship has been studied in several case-control studies, but only in a few cohort studies.

Methods

The association between allergic conditions and risk of developing leukemia, Hodgkin's disease, non-Hodgkin's lymphoma and myeloma was investigated in a cohort of 16,539 Swedish twins born 1886–1925. Prospectively collected, self-reported information about allergic conditions such as asthma, hay fever or eczema was obtained through questionnaires administered in 1967. The cohort was followed 1969–99 and cancer incidence was ascertained from the Swedish Cancer Registry.

Results

Hives and asthma tended to increase the risk of leukemia (relative risk [RR] = 2.1, 95% Confidence Interval [CI] 1.0–4.5 and RR = 1.6, 95% CI 0.8–3.5, respectively). There was also an indication of an increased risk of non-Hodgkin's lymphoma associated with eczema during childhood (RR = 2.3, 95% CI 1.0–5.3).

Conclusion

In contrast to most previous studies, our results do not indicate a protective effect of allergic conditions on the risk of developing hematological malignancies. Rather, they suggest that allergic conditions might increase the risk of some hematological malignancies.