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目的:综合分析肿瘤患者经自体外周血干细胞移植(APBSCT)治疗后出现粒细胞缺乏伴感染发热的特点、危险因素及预后。方法:对89例进行APBSCT治疗的患者进行回顾性调查研究,收集其粒细胞缺乏期的相关临床资料并分析其感染情况。结果:89例行APBSCT治疗患者均在干细胞回输后4d(0～15d)出现粒细胞缺乏,持续时间6d(3～27d)。粒细胞缺乏期感染发生率为78.7%(70/89),发热中位时间为3d(1～20d),无感染相关性死亡。发热患者使用抗生素治疗,其中44例(66.7%)初始治疗有效。34例(38.2%)患者的预防性抗感染用药中含抗真菌药物,但其中仍有25例(73.5%)出现发热。结论:感染是APBSCT粒细胞缺乏期主要并发症,粒细胞缺乏时间是感染的高危因素,预防性应用抗真菌药物未能降低感染发生率,早期、足量广谱抗生素治疗效果良好。
OBJECTIVE: To comprehensively analyze the characteristics, risk factors and prognosis of patients with fever with agranulocytosis after autologous peripheral blood stem cell transplantation (APBSCT) in cancer patients. Methods: A retrospective study of 89 patients undergoing APBSCT was performed. The clinical data of the patients with agranulocytosis were collected and their infection status was analyzed. Results: All 89 patients undergoing APBSCT showed agranulocytosis 4 days after transplantation (0-15 days), with a duration of 6 days (ranged from 3 to 27 days). The incidence of agranulocytosis was 78.7% (70/89), the median time to fever was 3d (1 ~ 20d), and no infection-related death. Fever patients treated with antibiotics, of which 44 patients (66.7%) initial treatment effective. Thirty-four patients (38.2%) had antifungal medication for prophylactic anti-infective use, but 25 (73.5%) still had fever. CONCLUSIONS: Infection is a major complication of agranulocytosis in APBSCT. Agranulocytosis is a risk factor for infection. Prophylactic use of antifungal agents failed to reduce the incidence of infection. Early treatment with adequate broad-spectrum antibiotics was effective.