中国循证医学杂志

中国循证医学杂志

乳腺癌和肺癌患者化疗后 Ⅳ 度粒细胞减少继发感染危险因素的病例-对照研究

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目的 分析乳腺癌和肺癌患者化疗后 Ⅳ 度粒细胞减少继发感染的危险因素,为制定预防乳腺癌和肺癌患者化疗后继发感染的措施提供参考依据。 方法 采用病例-对照方法,以 2014 年 1 月~2014 年 12 月西安交通大学第一附属医院化疗 Ⅳ 度粒细胞减少继发感染的乳腺癌、肺癌 37 例患者为病例组,以同期化疗 Ⅳ 度粒细胞减少未继发感染的乳腺癌、肺癌患者 87 例为对照组,通过回顾性收集病历资料,采用单因素和 Logistic 回归分析 Ⅳ 度粒细胞减少患者继发感染的危险因素。 结果 单因素分析显示,MASCC 评分<21 的 Ⅳ 度粒细胞减少患者感染风险更高(P<0.05),乳腺癌 Ⅳ 度粒细胞减少患者,前两个化疗周期继发感染风险是后续化疗周期的 2.9 倍;对于肺癌 Ⅳ 度粒细胞减少患者,侵入性操作和预防性使用抗菌药物均增加感染风险(P<0.05)。Logistic 回归分析表明 MASCC 评分和化疗周期与乳腺癌 Ⅳ 度粒细胞减少患者继发感染显著相关(P<0.05),侵入性操作与预防性使用抗菌药物是肺癌 Ⅳ 度粒细胞减少患者继发感染显著相关(P<0.05)。 结论 MASCC 评分和化疗周期是乳腺癌化疗致 Ⅳ 度减少继发感染的危险因素,肺癌侵入性操作与预防性使用抗菌药物是肺癌 Ⅳ 度粒细胞减少患者继发感染的危险因素。本研究为临床预防 Ⅳ 度粒细胞减少继发感染提供了一定的参考信息。

Objective To analyze the risk factors of secondary infections in patients with chemotherapy-induced degree Ⅳ neutropenia, to put forward the reference for clinical treatment. Methods The case-control design methods was used, thirty-seven in-patients of breast cancer or lung cancer with secondary infections and eight-seven in-patients without secondary infection were enrolled as study population in the First Affiliated Hospital of Xi’an Jiaotong University from January to December 2014. Through a retrospective information to analysis the risk factor of secondary infection with chemotherapy-induced degree Ⅳ neutropenia, using factors under univariate analysis and logistic regression analysis. Result Single factor analysis showed that the patient have higher infection risks which was MASCC<21 (P<0.05). Breast cancer patient with degree Ⅳ neutropenia that the first two chemotherapy cycles of secondary infection risk was 2.9 times of subsequent cycles of chemotherapy. For lung cancer patient with Ⅳ neutropenia, invasive operation and preventive use of antibiotics increased risk of infection (P<0.05). Logistic regression analysis showed that MASCC score and cycles of chemotherapy was significantly associated with secondary infection in breast cancer Ⅳ neutropenia (P<0.05). Invasive operation were significantly correlated to secondary infection of patient with lung cancer Ⅳ neutropenia (P<0.05). Conclusion MASCC score and cycles of chemotherapy are the risk factors of infection in breast cancer patient with Ⅳ neutropenia, and invasive operation is the independent risk factors of infection in Ⅳ neutropenia of lung cancer. This study provides the reference of prevent secondary infection in clinical.

关键词: 乳腺癌; 肺癌; 粒细胞减少; 感染; 病例-对照研究

Key words: Breast cancer; Lung cancer; neutropenia; infection; Case-control study

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1. 李亚丽, 肖佳灵, 杨克虎, 等. 卡培他滨联合多西紫杉醇治疗转移性乳腺癌的系统评价. 中国循证医学杂志, 2009, 9(8): 893-898.
2. 米登海, 李征, 田金徽, 等. 热放化三联疗法治疗非小细胞肺癌的 Meta 分析. 中国循证医学杂志, 2011, 11(11): 1262-1267.
3. 王大志, 庄安士, 张书瑜. 抗肿瘤药与呼吸系统恶性肿瘤化疗患者骨髓抑制发生风险的 Logistic 回归分析. 药物流行病学杂志, 2012, 21(8): 365-367.
4. 李莉, 张萍, 康焕珍, 等. 肿瘤化疗骨髓抑制期医院感染的危险因素分析. 中华医院感染学杂志, 2013, 23(18): 4394-4398.
5. 常瑞, 张慧敏. 肿瘤患者化疗期间Ⅳ度骨髓抑制致院内感染的护理. 中国临床护理, 2015, 7(4): 333-334.
6. ESMO. ESMO recommendations for the application of hematopoietic growth factors (rGFs). Ann Oncol, 2001, 12(9): 1219-1220.
7. 胡萨萨, 尤海生. 化疗致肺癌患者粒细胞减少危险因素的回顾性分析. 药物流行病学, 2015, 24(6): 356-357.
8. 程伏林, 胡名柏, 袁宏银. 化疗所致粒细胞缺乏症患者医院感染危险因素的多因素 Cox 模型分析. 中华医院感染学杂志, 2002, 12(5): 327-328.
9. 中国医学会血液学分会. 中国粒细胞缺乏伴发热患者抗菌药物临床应用指南. 中国血液学杂志, 2016, 37(5): 353-358.
10. 阮燕萍. 化疗致粒细胞缺乏症者发热及感染的病例对照研究. 杭州: 浙江大学, 2007: 11, 18-19.
11. Combariza JF, Lombana M, Pino LE, et al. C-reactive protein and the MASCC risk index identify high-risk patients with febrile neutropenia and hematologic neoplasms. Support Care Cancer, 2015, 23(4): 1009-1013.
12. Klastersky J, Paesmans M. The Multinational Association for Supportive Care in Cancer (MASCC) risk index score: 10 years of use for identifying low-risk febrile neutropenic cancer patients. Surport Care Cancer, 2013, 21(5): 1487-1495.
13. 余树娥, 汪蓓, 徐建华. rhG-GSF 对肿瘤患者化疗后白细胞减少及粒细胞缺乏的疗效. 湖南医学, 2002, 19(2): 100-101.
14. 王军, 刘勇. MASCC 危险指数评分和降钙素原应用于血液病化疗后粒细胞缺乏伴发热的价值. 实用医学杂志, 2015, 31(8): 1277-1279.
15. 阮艳萍, 张文英. 化疗致粒细胞缺乏症患者发热与感染的关系. 癌症, 2008, 27(8): 879-881.
16. 李伟伟, 崔艳慧, 蔡卫梅. 肺癌患者化疗期间发生感染的相关危险因素分析. 中国医院感染学杂志, 2013, 23(6): 1277-1278.
17. 张强. 细胞集落刺激因子和抗菌药物预防化疗所致粒细胞缺乏症患者院内感染的疗效观察. 中国实验和临床感染病杂志, 2013, 7(4): 108-109.
18. 程伏林, 胡名柏, 林从尧, 等. 化疗致粒细胞缺乏症患者的院内感染. 实用癌症杂志, 2001, 16(6): 613.