急性髓系白血病患者化疗后血清IL-8、IL-6水平与感染的关系

目的：探讨急性髓系白血病(AML)患者化疗后粒细胞缺乏发热时血清白细胞介素8(IL-8)和白细胞介素6(IL-6)水平与感染的关系。方法：采用双抗体夹心酶联免疫吸附法(ELISA)检测42例AML患者和20名正常对照者血清IL-8、IL-6水平。结果：血清IL-8和IL-6水平在AML患者发热第1天均升高，其中病原学检查阳性组显著高于原因不明发热组(P均＜0.002)和仅有临床感染证据组(P均＜0.05)，仅有临床感染证据组也较原因不明发热组增高(P均＜0.02)，且革兰氏阴性菌感染者较革兰氏阳性菌感染者增高明显(P均＜0.01)；IL-8和IL-6呈显著正相关(r=0.841，P＜0.001)，并均与体温呈正相关(r=0.447和0.570，P＜0.005和P＜0.001)；并发败血症死亡患者的血清IL-8、IL-6水平呈持续增高。结论：应用夹心法ELISA联合检测血清IL-8、IL-6水平，将有助于确定AML患者化疗后粒细胞缺乏发热时的早期感染及其严重性。     

降钙素原在恶性血液病化疗后中性粒细胞缺乏合并感染中的临床意义

目的探讨降钙素原(PCT)在恶性血液病化疗后中性粒细胞缺乏患者合并感染时对病原体诊断的临床意义。方法根据感染的微生物类型,将135例入组患者分为细菌感染组、真菌感染组和病毒感染组;细菌感染组中微生物学确诊为G-菌感染组和G+菌感染组。除行常规血培养及感染灶分泌物培养等检查外,均在发热12 h内行血清PCT测定。PCT测定采用快速半定量固相免疫测定法。综合分析患者的临床表现、微生物检查、影像学检查及治疗疗效回顾性诊断患者感染的微生物类型。结果细菌感染组血清PCT值较真菌感染组及病毒感染组均明显增高,差异均有统计学意义(P均<0.05);真菌感染组与病毒感染组比较差异无统计学意义(P>0.05);G-菌感染组较G+菌感染组PCT值增高(P<0.05)。结论在恶性血液病化疗后中性粒细胞缺乏合并感染的患者中,血清PCT值对预测细菌感染是一个快速可靠的指标。血清PCT值越高,细菌感染可能性越大,G-菌感染可能性更大。对于真菌感染、病毒感染诊断具有阴性预测意义。     

白血病粒细胞缺乏期重度肠道细菌感染二例并文献复习

 　目的　提高对白血病粒细胞缺乏期重度肠道细菌感染的了解及认识。方法　对2例急性白血病患者粒细胞缺乏期重度肠道感染的临床资料、诊断及治疗经过进行分析,并复习文献。结果　2例急性白血病粒细胞缺乏期重度肠道感染患者中,1例患者经积极的综合治疗感染逐渐被控制,1例患者发生感染性休克抢救无效死亡。结论　白血病粒细胞缺乏期重度肠道感染进展迅速,须早期作出诊断并采取及时的综合治疗措施。     

血清白细胞介素-6和降钙素原水平与急性淋巴细胞白血病患儿预后的关系

目的 分析血清中白细胞介素-6(IL-6)和降钙素原（PCT）水平与急性淋巴细胞白血病（ALL）患儿预后的相关性。方法 选取88例ALL患儿（作为观察组）和57例非恶性血液病患儿（作为对照组）,采用酶联免疫吸附试验检测血清IL-6水平,采用免疫荧光层析法检测血清PCT水平。比较不同临床特征ALL患儿血清IL-6和PCT水平,分析血清IL-6和PCT水平与ALL患儿预后的关系。结果 观察组患儿血清IL-6、PCT水平均明显高于对照组,差异均有统计学意义（P﹤0.01）。不同Risk分层、白细胞计数、血红蛋白水平、血小板计数、原始细胞比例的ALL患儿血清IL-6、PCT水平比较,差异均有统计学意义（P﹤0.01）。以血清IL-6水平22.17 pg/ml为临界值将88例ALL患儿分为IL-6高表达组（n=52,≥22.17 pg/ml）和IL-6低表达组（n=36,﹤22.17 pg/ml）,IL-6高表达组ALL患儿的中位无进展生存期（PFS）为12个月（95%CI:10.2～17.4个月）,明显短于IL-6低表达组患儿的19个月（95%CI:13.5～22.9个月）,差异有统计学意义（...     

恶性肿瘤伴脓毒血症患者炎症指标及预后评估分析

目的探讨恶性肿瘤伴脓毒血症患者的降钙素原(PCT)、白介素6(IL-6)、C-反应蛋白(CRP)、白细胞计数(WBC)和血沉(ESR)等炎症指标及预后。方法选取2016年7月至2017年2月间同济医学院附属同济医院收治的73例恶性肿瘤伴脓毒血症感染患者为观察组,选取同期住院的60例非肿瘤脓毒血症患者为对照组。检测并比较两组患者的PCT、IL-6、CRP、WBC和ESR水平,评估两组患者的急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)和序贯器官衰竭评估(SOFA)状况。结果观察组患者的IL-6、CRP和ESR水平均比对照组患者高,WBC较对照组患者低,差异均有统计学意义(均P<0.05)。但两组患者PCT水平无明显变化,差异无统计学意义(P>0.05)。结论恶性肿瘤伴脓毒血症患者可通过联合检测PCT、IL-6、CRP、WBC和ESR水平判断感染情况,其中PCT不受肿瘤干扰,对早期诊断、指导临床应用抗菌素及评估预后有重要意义。     

碳青霉烯类治疗儿童白血病粒细胞缺乏感染52例临床疗效观察

目的观察碳青霉烯类(亚胺培南、美罗培南)治疗儿童白血病粒细胞缺乏感染的临床疗效。方法对52例儿童急性白血病化疗或脐血移植后中性粒细胞缺乏合并感染患者,在使用其他常用的广谱抗生素无效的情况下改用亚胺培南或美罗培南,结合细菌培养结果价治疗效果及不良反应。结果亚胺培南和美罗培南治疗的有效率达85.2%、84.0%,疗效相近。美罗培南主要优势是对铜绿假单胞菌疗效更优,不易诱导耐药,副作用少。亚胺培南对嗜麦芽寡养单胞菌全部耐药。美罗培南平均退热时间长于亚胺培南。结论美罗培南治疗儿童急性白血病患者中性粒细胞缺乏时感染的效果明显且较安全。     

血清超敏C反应蛋白、降钙素原与血小板参数与白血病患者病情的相关性

目的 探讨血清超敏C反应蛋白、降钙素原与血小板参数在白血病患者血清中的表达水平,并分析其与白血病患者病情的相关性.方法 选取100例白血病患者作为研究对象进行回顾性分析,依照患者病情严重程度,将其分为A组、B组和C组.A组患者为白血病未感染患者,共28例;B组患者为白血病轻微感染患者,共51例;C组为白血病脓毒症患者,...     

血清降钙素原与C-反应蛋白联合检测急诊恶性肿瘤患者早期感染的价值

目的:探讨血清降钙素原与C-反应蛋白联合检测急诊恶性肿瘤患者早期感染的价值研究。方法:选取我院于2015年12月至2017年1月期间收治的急诊恶性肿瘤早期感染患者67例为观察组;另选取我院于2015年12月至2017年1月期间收治的恶性肿瘤未感染患者60例为对照组。均于入院后空腹采集外周静脉血,分离血清,采用电化学发光法测定降钙素原含量,采用免疫比浊法测定C-反应蛋白含量。比较两组血清C-反应蛋白和降钙素原含量、C-反应蛋白和降钙素原阳性率及C-反应蛋白联合降钙素原诊断的灵敏度和特异度。结果:观察组血清C-反应蛋白和降钙素原含量高于对照组,且有统计学差异（P<0.05）;观察组C-反应蛋白和降钙素原阳性率高于对照组,且有统计学差异（P<0.05）;C-反应蛋白联合降钙素原诊断灵敏度和特异度高于 C-反应蛋白和降钙素原单项诊断,具有统计学差异（P<0.05）。结论:急诊恶性肿瘤患者早期感染血清降钙素原与C-反应蛋白含量升高,C-反应蛋白联合降钙素原诊断的灵敏度和特异度高,具有重要研究意义。     

白血病化疗后粒细胞缺乏伴真菌感染患者抗菌药物的应用研究

目的 探究白血病化疗后粒细胞缺乏伴真菌感染患者抗菌药物的使用情况,为临床制定合理使用抗生素方案提供参考依据.方法 回顾性分析淄博市中心医院收治的110例白血病化疗后粒细胞缺乏伴真菌感染患者的一般资料,采用该院自制的白血病化疗后粒细胞缺乏伴真菌感染患者抗菌药物使用情况调查表进行统计,最后根据统计结果进行分析.结果 110例患者中感染部位主要为呼吸道(47.27％)、其次为口腔或消化道(32.73％);通过经验性用药治疗有效率占60.91％;43例经验救治无效后使用补救方案治疗后,有效率达到93.02％,其中1例由于产生不良反应而停止使用,1例由于因感染性休克死亡.经验性用药为单一他唑巴坦/哌拉西林(27.27％)、伊曲康唑(10.00％),而联合用药主要为伊曲康唑+头孢他啶(17.27％),其次为伊曲康唑+万古霉素(9.09％);在经验治疗无效后,使用抗菌药物频率最高的为单一使用氟康唑(23.26％),其次为哌拉西林/他唑巴坦(16.28％),联合用药频率最高的为氟康唑+万古霉素(9.30％),其次为哌拉西林/他唑巴坦+万古霉素(6.98％).结论 该院抗菌药物使用情况合理,针对白血病化疗后粒细胞缺乏伴真菌感染患者应根据患者感染情况,合理选择抗菌药物.     

亚胺培南经验性治疗肿瘤患者中性粒细胞缺乏伴发热的回顾性分析

目的评价碳青酶烯类抗生素亚胺培南经验性治疗肿瘤患者中性粒细胞缺乏伴发热的疗效和安全性。方法回顾性分析51例肿瘤患者化疗后出现中性粒细胞缺乏伴发热应用亚胺培南进行经验性治疗的临床资料。结果接受亚胺培南/西司他丁进行初始经验性治疗的51例患者中,痊愈29例,显效8例,进步7例,无效7例,有效率72.5%。2例患者出现了可耐受的不良反应。结论亚胺培南作为肿瘤患者中性粒细胞缺乏伴发热的初始经验性抗菌治疗,具有较高的疗效和良好的耐受性。     

Antibiotic prophylaxis during chemotherapy-induced neutropenia for patients with acute leukemia

Chemotherapy-induced neutropenia places patients with acute leukemia at high risk for bacterial infections. A number of studies performed over the past 20 years have investigated the utility of prophylactic antimicrobials, including trimethoprim-sulfamethoxazole and fluoroquinolones, to prevent infection in the setting of mucositis and neutropenia. Many of these studies have found a benefit of prophylaxis in terms of the incidence of fever and bacterial infection. Clinical guidelines do not recommend antibacterial prophylaxis, however, in part because of increasing reports of infections due to resistant organisms, including fluoroquinolone-resistant Escherichia coli, fluoroquinolone-insensitive viridans streptococci, and Clostridium difficile. To effectively use prophylaxis and simultaneously limit emerging antibiotic resistance, only patients at high risk for bacterial infections should receive prophylaxis.     

DNA-PKcs和Bcl-2在急性白血病细胞中的表达及相关性研究

目的：研究DNA-PKcs和Bcl-2在急性白血病（AL）细胞中的表达及相关性。方法：采用免疫组化SP法检测62名初治AL患者骨髓白血病细胞DNA-PKcs和Bcl-2的表达。结果：DNA-PKcs在对化疗药物耐药患者白血病细胞中的表达率（51.5%）明显高于敏感组（20.7%）,P〈0.05。Bcl-2在对化疗药物耐药患者白血病细胞中的表达率（84.8%）明显高于敏感组（62.1%）,P〈0.05。耐药组患者的白血病细胞中DNA-PKcs（＋）/Bcl-2（＋）,DNA-PKcs（＋）/Bcl-2（-）,DNA-PKcs（-）/Bcl-2（＋）和DNA-PKcs（-）/Bcl-2（-）细胞的百分率分别是88.2%,33.3%,44.8%和30.0%,DNA-PKcs（＋）/Bcl-2（＋）与DNA-PKcs（＋）/Bcl-2（-）、DNA-PKcs（-）/Bcl-2（＋）和DNA-PKcs（-）/Bcl-2（-）之间差异均有统计学意义（P〈0.05,P〈0.01,P〈0.01）。33名耐药组患者中,DNA-PKcs和Bcl-2的表达无相关性,r=0.171,P〉0.05。29名敏感组患者中,DNA-PKcs和Bcl-2的表达呈负相关,r=-0.45,P〈0.05。结论：DNA-PKcs可能下调Bcl-2的表达,AL患者的白血病细胞中DNA-PKcs和Bcl-2表达水平增高与临床耐药密切相关。     

化疗致粒细胞缺乏症患者发热与感染的关系

背景与目的:恶性肿瘤化疗后粒细胞缺乏症患者常继发发热和感染,但临床对发热患者是否存在感染持有异议。本研究旨在了解化疗致粒细胞缺乏症患者发热及感染的发生情况,并探讨两者之间的关系。方法:调查2007年1月至7月,因化疗致粒细胞缺乏症在浙江省肿瘤医院住院的256例恶性肿瘤患者,对其中发生发热及感染的病例进行描述性分析和一致性检验。结果:256例病例中共发生发热100例(39.1%),感染42例(16.4%)。发热者体温(39.0±0.6)℃。感染部位主要见于咽部(42.9%)、口腔(21.4%)和下呼吸道(14.3%)。发热与感染病例一致性检验结果Kappa值为0.414(P<0.001),一致率为0.75。结论:化疗致粒细胞缺乏症者发热及感染的发生率较高,且发热与感染呈中度一致。     

Intensified prophylaxis of febrile neutropenia with ofloxacin plus rifampin during severe short-duration neutropenia in patients with lymphoma.

To analyse the impact of intensified prophylaxis with ofloxacin plus rifampin (O+R) in neutropenic patients we used this combination in 40 consecutive cycles of ifosfamide, cytarabine, prednisolone and etoposide (IAPVP-16). This salvage chemotherapy regimen for lymphoma usually produces four to six days of severe neutropenia without significant extrahematologic toxicities. We compared the infectious morbidity during neutropenia under O+R with 58 consecutives cycles using either norfloxacin or no prophylaxis (control group). Fifty-three percent of control group patients and 20% of the O+R group developed febrile neutropenia that required hospital admission (p<0.001, 95% CI for the difference between both proportions of 16% to 51%). Bacteremia was documented in two patients in the O+R group and six in the control group (p=0.08). Gram-positive cocci (GPC) accounted for all six bacteremias in the control group, while both cases in O+R group were due to a quinolone-resistant gram-negative bacteria (GNB) (p<0.01 for GPC). Five patients (13%) who received O+R and 23 (40%) in control group developed fever of unknown origin, p<0.001, while the total duration of hospitalization due to febril neutropenia was 42 days and 158 days, respectively (p<0.001). In conclusion, intensified prophylaxis with O+R appears to reduce the rate of febrile neutropenia and GPC bacteremia in patients with short and severe neutropenia, which translates into a reduction in the need for hospitalization.     

Invasive fungal disease in pediatric acute leukemia patients with fever and neutropenia during induction chemotherapy: a multivariate analysis of risk factors

We evaluated the courses of 115 consecutive cases of pediatric acute leukemia treated with induction chemotherapy. Seventy-two patients developed fever associated with neutropenia; 15 developed systemic fungal infections. We reviewed multiple demographic and treatment characteristics of these patients in an attempt to identify potential risk factors for the development of invasive fungal disease (IFD). Risk factors identified in a univariate analysis included duration of neutropenia after first fever (P less than .0001), diagnosis of acute nonlymphocytic leukemia (ANLL) (P = .003), onset of fever and neutropenia within 5 days of starting induction chemotherapy (P = .009), and multiple (greater than one) surveillance culture sites positive for fungal organisms (P = .02). In a multiple logistic regression analysis, duration of neutropenia (P less than .001) remained a significant risk factor. The study group of patients had a significantly higher risk of fungal infections than a matched group of leukemia patients developing fever with neutropenia due to postremission consolidation chemotherapy (P = .003). In the first 48 patients, 14 (29%) developed IFD. In the subsequent patients (n = 24), intravenous miconazole (5 mg/kg every 8 hours) was begun at the time of the first fever. One of the 24 patients (4%) given miconazole developed IFD. The use of miconazole was a negative risk factor for the development of IFD in univariate (P = .01) and multivariate (P = .05) analysis. We conclude that pediatric leukemia patients who develop fever associated with neutropenia during induction chemotherapy are at high risk for developing IFD. The role of intravenous miconazole at the time of the first fever in this group deserves further study.     

CEA levels in serum and BAL in patients suffering from lung cancer

Background Carcinoembryonic antigen (CEA) is a tumor marker belonging to the immunoglobulin gene superfamily of adhesion molecules. CEA is synthesized by epithelial and tumor cells. In this study, CEA levels in sera and bronchoalveolar lavage fluid (BAL) were measured in patients with malignant lung cancer and benign lung diseases. Methods In the present study CEA was measured in serum using IRMA methods and in bronchoalveolar lavage of individuals undergoing fiberoptic bronchoscopy. Fifty patients with lung cancer (G1), 20 patients with benign lung lesions (G2), and a control group consisted of 20 individuals (G3) were enrolled in the study. Results We found that serum CEA levels were significantly higher in G1 compared to G2 and G3 (p < 0.01). No significant difference in serum CEA levels was found between smokers and nonsmokers in any of the three groups studied. CEA was significantly higher in G1 BAL (p < 0.05) compared to G2 and G3 BAL. Furthermore, a statistically significant difference was found in CEA levels in BAL between smokers and nonsmokers of G2. Conclusions CEA levels in BAL of normal individuals may be influenced by smoking and other factors that affect lung epithelial cell function. Thus, CEA measurement in BAL alone has little value in the diagnosis of malignancy. BAL CEA levels in smokers of G2 are found significantly higher compared with nonsmokers of the same group and healthy individuals. Smokers of G2 have to be followed up carefully for the possibility of lung cancer growth.     

伏立康唑一级预防急性白血病患者化疗期间并发真菌感染的临床疗效北大核心

目的:探讨初诊急性白血病患者化疗期间应用伏立康唑进行预防侵袭性真菌病(IFD)的临床疗效及安全性。方法:回顾性分析2016年02月至2018年03月期间我院血液科收治的初诊急性白血病行化疗的患者166例,按照是否使用抗真菌药进行预防性治疗分为观察组(应用伏立康唑进行预防治疗,n=103)和对照组(未应用抗真菌药物,n=63),比较两组患者IFD发生率差异,并分析抗真菌药物应用的不良反应。结果:观察组IFD发生率为10.7%,对照组为33.3%,两组患者的IFD发生率有明显差异(P<0.05);所有应用伏立康唑进行预防治疗的患者均未出现严重的不良反应。结论:伏立康唑可以有效减低急性白血病患者化疗期间IFD发生率,并且有着较好的安全性,值得在临床推广应用。