去甲氧柔红霉素联合阿糖胞苷诱导化疗期间急性髓系白血病患者感染发生情况及危险因素分析

Infection occurrence and risk factor analysis in patients with acute myeloid leukemia during idarubicin plus cytarabine induction chemotherapy

摘要:

目的 探讨去甲氧柔红霉素联合阿糖胞苷（IA）诱导化疗期间急性髓系白血病（AML）患者感染发生情况及危险因素。方法 选取2021年1月—2025年6月安徽医科大学附属阜阳人民医院172例AML患者为研究对象，患者均接受IA诱导化疗。根据治疗期间是否发生医院感染将患者分为感染组（70例）、未感染组（102例）。比较两组的临床资料及检测指标。采集感染患者的痰液或其他分泌物进行病原微生物培养，详细记录感染部位和病原检测结果。采用多因素一般Logistic回归模型分析发生医院感染的影响因素，建立列线图模型，并通过校准曲线评估预测模型的拟合效果。结果 感染组年龄、住院时间、化疗次数≥2次占比、未预防性使用抗生素占比、低蛋白血症发生率、粒细胞缺乏时间≥7 d占比均高于未感染组（P <0.05），白细胞计数低于未感染组（P <0.05）。多因素一般Logistic回归分析结果显示：住院时间长［O^R =1.472（95% CI：1.294，1.675）］、粒细胞缺乏时间长［O^R =3.650（95% CI：1.491，8.940）］、低蛋白血症［O^R =3.351（95% CI：1.353，8.301）］均为AML患者IA诱导化疗期间发生医院感染的危险因素（P <0.05），预防性使用抗生素［O^R =0.233（95% CI：0.097，0.559）］为保护因素（P <0.05）。结论 住院时间长、粒细胞缺乏时间≥7 d、合并低蛋白血症是AML患者IA诱导化疗期间发生感染主要危险因素，而预防性使用抗生素可降低感染风险。

Abstract:

Objective To investigate the occurrence of infection and risk factors in patients with acute myeloid leukemia (AML) during induction chemotherapy with idarubicin plus cytarabine (IA) regimen.Methods A total of 172 AML patients admitted to Fuyang People's Hospital Affiliated to Anhui Medical University from January 2021 to June 2025 were selected as the research subjects, and all patients received IA induction chemotherapy. According to whether nosocomial infection occurred during treatment, the patients were divided into an infection group (n = 70) and a non-infection group (n = 102). The clinical data and test indicators of the two groups were compared. Sputum or other secretions of infected patients were collected for pathogenic microorganism culture, and the infection sites and pathogenic detection results were recorded in detail. A multivariate general Logistic regression model was used to analyze the influencing factors of nosocomial infection, a nomogram model was established, and the fitting effect of the prediction model was evaluated by calibration curve.Results The age, length of hospital stay, proportion of patients with ≥2 chemotherapy cycles, proportion of patients without prophylactic use of antibiotics, incidence of hypoproteinemia, and proportion of patients with agranulocytosis duration ≥7 days in the infection group were all higher than those in the non-infection group (P < 0.05), while the white blood cell count was lower than that in the non-infection group (P < 0.05). The results of multivariate general Logistic regression analysis showed that longer length of hospital stay [O^R = 1.472 (95% CI: 1.294, 1.675) ], longer agranulocytosis duration [O^R = 3.650 (95% CI: 1.491, 8.940) ], and hypoproteinemia [O^R = 3.351 (95% CI: 1.353, 8.301) ] were risk factors for nosocomial infection in AML patients during IA induction chemotherapy (P < 0.05), and prophylactic use of antibiotics [O^R = 0.233 (95% CI: 0.097, 0.559) ] was a protective factor (P < 0.05).Conclusion Long length of hospital stay, agranulocytosis duration ≥7 days, and complicated hypoproteinemia are the main risk factors for nosocomial infection in AML patients during IA induction chemotherapy, while prophylactic use of antibiotics can reduce the infection risk.