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目的 了解重型再生障碍性贫血 (SAA)患者并发感染的临床特征。方法 回顾性分析2 2 9例SAA患者并发感染的患病率及影响因素 ,SAA患者并发感染的细菌谱 ,在常规抗感染治疗基础上并用GM CSF或G CSF对疗效的影响。结果 SAA患者并发感染的患病率为 86 .0 % ,G+ 菌占5 4 2 % ,G-杆菌占 4 0 .0 % ,真菌占 5 .8% ;血培养G-杆菌以大肠艾希菌及绿脓杆菌为主。感染主要是与患者中性粒细胞绝对值 (N)降低有关 ,N <0 .2× 10 9/L感染率显著增高 ,且感染时间显著延长 ,N <0 1× 10 9/L者易发生 2个部位以上的感染 ;患者年龄、贫血程度、T细胞亚群分布、是否用抗人胸腺细胞球蛋白 (ATG)不影响感染的发生 ;预防性使用氟嗪酸不能减少肠道感染。SAA患者并发感染总病死率为 2 3.1% ,发生肺部感染及败血症的患者病死率增高 ,而使用GM CSF或G CSF组感染的病死率较低。结论 SAA患者是并发感染的高危人群 ,影响感染的主要因素是中性粒细胞减少 ;在合理使用抗生素的基础上并用造血细胞生长因子可能有助于提高抗感染的疗效。
Objective To understand the clinical features of concurrent infection in patients with severe aplastic anemia (SAA). Methods The prevalence and influential factors of concurrent infection in 299 patients with SAA were retrospectively analyzed. The bacterial spectrum of concurrent infection in patients with SAA was retrospectively analyzed. The effects of GM CSF or G CSF on the therapeutic efficacy were compared with conventional anti-infective therapy. Results The prevalence of concurrent infection in SAA patients was 86.0%, G + bacteria accounted for 54.2%, G-bacteria accounted for 40.0%, and fungi accounted for 5.8%. Blood cultures of G- Pseudomonas aeruginosa and the main. Infection was mainly associated with a decrease in neutrophil absolute value (N), a significant increase in the infection rate of N <0 .2 × 10 9 / L, and a significant prolongation of infection time, with an incidence of N <0 1 × 10 9 / L Infections with more than two sites; age of patient, degree of anemia, distribution of T cell subsets, whether or not the use of anti-human thymocyte globulin (ATG) does not affect the occurrence of infection; prophylactic use of flurazinonic acid can not reduce intestinal infections. The overall case fatality rate of complicated infection in SAA patients was 23.1%. The case fatality rate of patients with pulmonary infection and sepsis increased while the case fatality rate of patients with GM CSF or G CSF was lower. Conclusions SAA is a high risk group with complicated infection. The main factor affecting infection is neutropenia. Combining rational use of antibiotics with hematopoietic growth factor may help to improve the anti-infective efficacy.