多发性骨髓瘤合并侵袭性真菌感染的临床特点及易感因素分析

目的 了解多发性骨髓瘤(MM)患者合并侵袭性真菌感染(IFI)的临床特点及易感因素.方法 回顾357例在我院住院诊治的MM患者,记录是否合并 IFI、一般临床资料、并发病、抗真菌治疗以及疗效和毒副作用.结果 44例(12.3%)患者在治疗过程中曾发生IFI,其中3例(6.8%)为确诊病例,8例(18.1%)为临床诊断,33例(75.0%)为拟诊.44例患者中,10例(22.7%)处于诱导化疗时出现真菌感染;4例(9.1%)为平台期;27例(61.4%)处于疾病进展状态;3例(6.8%)在行自体造血干细胞移植的过程中发生真菌感染.感染部位以肺部最常见,占50.O%.两性霉素B、伏立康唑、伊曲康唑、卡泊芬净、氟康唑的有效率分别为83.3%、75.O%、78.9%、75.O%和57.1%.各种抗真菌药物之间疗效比较差异无统计学意义(P=0.493).根据多因素分析,合并糖尿病(P=0.035,OR 2.527,95%CI 1.005～6.052),接受透析治疗(P=0.022,OR 2.768,95%CI 1.161～6.600)、粒细胞缺乏持续时间超过1周(P:0.019,OR 3.215,95%CI 1.200～7.407),之前是否使用广谱抗生素治疗(P=0.009,OR 3.350,95%CI 1.353～8.295),是否使用氟达拉滨(P=0.001,OR 4.669,95%CI1.813-12.023)差异有统计学意义.结论 MM患者是侵袭性真菌感染的高危人群,肺部是其最常见的感染部位,4种抗真菌药的疗效相当,合并糖尿病、化疗同时接受透析治疗、长时间粒细胞缺乏、广谱抗生素的应用、以及含有氟达拉滨的治疗是MM合并IFI的易感因素.

The clinical features and risk factors for invasive fungal infection in multiple myeloma

Objective To study the clinical features and risk factors of invasive fungal infection (IFI) in multiple myeloma ( MM) . Methods Three hundred and fifty-seven cases of MM were retrospectively analyzed for IFI, clinical features, complicating diseases, treatment of fungus and side effect of anti-fungal drugs. Results Forty-four cases ( 12. 3% ) of IFI were diagnosed. Three of them were diagnosed definitely, 8 clinically and 33 probably. Ten cases incurred IFI in (he induction therapy, 4 in platform, 27 in progress and 3 in the treatment with autologous stem cell transplantation. The lung was the commonest site of infection ( 50. 0% ) . The total effective rates of amphotericin B liposome, voriconazole, itraconazole, caspofungin and fluconazol were 83. 3% , 75. 0% , 78. 9% , 75. 0% and 57. 1% respectively (P= 0.493). In a multivariate analysis, independent factors significantly associated with IFI were diabetes (P=0.035, OR 2. 527, 95%CI 1.005-6.052), dialysis (P=0. 022,OR 2. 768, 95%CI 1. 161-6. 600), persistent agranulocytosis (P = 0.019, OR 3.215, 95% CI 1.200-7.407), broad-spectrum antibiotic therapy (P = 0.009,OR 3. 350,95% CI 1.353-8.295) and fludarabine treatment( P = 0. 001,0R 4. 669, 95% CI 1.813-12.023). Conclusions Patients with MM are in high risk of IFI. The lung is the commonest site of infection. The therapeutic effect was similar with itraconazole, voriconazole, caspofungin and amphotericin B liposome in MM patients with complicating IFI. The risk factors for IFI in MM were diabetes, dialysis, persistent agranulocytosis and the use of broad-spectrum antibiotics and fludarabine.