初诊骨髓增生异常综合征患者感染的临床特征及其与疗效的关系

目的:探讨骨髓增生异常综合征(MDS)患者感染的特点、重症感染的危险因素及其与疗效的关系。方法:回顾性分析2016年1月至2020年6月本院血液科病房收治的92例院内感染的初诊MDS患者临床资料。结果:92例初诊MDS患者共完成306个疗程,以第一疗程感染率最高(84.8%,78/92),后逐渐下降。感染部位前3位依次是肺部、上呼吸道、胃肠道。共检出病原菌90株,其中革兰阴性杆菌占33.3%(30/90),革兰阳性球菌占23.3%(21/90),真菌占23.3%(21/90),病毒占20.0%(18/90)。92例MDS患者中重症感染率为22.8%(21/92)。多因素分析显示,中性粒细胞缺乏时间>7 d(OR=10.875,95%CI:2.747-43.051,P=0.001)是MDS患者重症感染的独立危险因素。与非重症感染组相比,重症感染组总有效率较差(90.9%vs 63.6%,χ2=4.393,P<0.05)。结论:MDS患者第一疗程感染率高,最常见感染部位是肺部,病原菌以革兰阴性杆菌多见。中性粒细胞缺乏时间>7 d的MDS患者重症感染风险高,疗效差。

Clinical Features of Infection in Newly Diagnosed Patients with Myelodysplastic Syndrome and Its Correlation with Curative Effect

Objective:To explore the characteristics of infection in patients with myelodysplastic syndromes(MDS),risk factors of serious infection,and their correlation with curative effect.Methods:The clinical data of 92 newly diagnosed MDS patients with nosocomial infection from January 2016 to June 2020 in our hospital were retrospectively analyzed.Results:A total of 306 courses of treatment were completed in 92 newly diagnosed MDS patients.The infection rate was the highest in the first course of treatment(84.8%,78/92),and then decreased gradually.The top three infection sites were lung,upper respiratory tract,and gastrointestinal tract.A total of 90 strains of pathogenic bacteria were detected,of which 33.4%(30/90) were gram-negative bacilli,23.3%(21/90) were gram-positive cocci,23.3%(21/90)were fungi,and 20.0%(18/90) were viruses.The serious infection rate among 92 patients with MDS was 22.8%(21/92).Multivariate analysis showed that neutrophil deficiency>7 days(OR=10.875,95%CI:2.747-43.051,P=0.001) was an independent risk factor for serious infection in MDS patients.Compared with non-severe infection group,the total effective rate of severe infection group was lower(90.9% vs 63.6%,χ²=4.393,P<0.05).Conclusion:The infection rate of MDS patients is high in the first course of treatment,and the most common infection site is the lung.Gram-negative bacteria is the most common pathogen.MDS patients with neutrophil deficiency>7 days have a high risk of serious infection and poor efficacy.