感染性疾病伴血小板减少症的临床分析
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摘要
目的研究感染性疾病伴血小板减少症患者的病因构成及影响预后的危险因素,对诊断、治疗及预防提供帮助。方法收集2016年1月-2018年7月入住我院的203例感染疾病伴血小板减少症患者的临床和实验室资料,回顾性分析患者的病因、感染的病原体、血小板减少程度及其与临床预后有关的危险因素。结果感染的病因以多系统感染、呼吸系统和泌尿系统感染为主,感染病原体以细菌感染最多见,其次为病毒感染和混合感染,常见细菌为肺炎克雷白杆菌、大肠埃希菌以及鲍曼复合醋酸钙不动杆菌为主的革兰阴性杆菌。血小板减少程度以I度多见,IV度少见。病毒感染引起的血小板减少比细菌感染引起的下降更明显,差异有统计学意义(P<0.05);其中年龄≥65岁、伴有严重基础疾病、有并发症、入院时白细胞≥12×10~9/L的患者与无上述条件的患者比较预后差(P<0.05)。通过logistic回归分析,发现年龄≥65岁、出现并发症为感染伴血小板减少预后差的独立危险因素。结论感染相关血小板减少症的患者以多系统感染、细菌感染最常见,但病毒感染引起血小板减少比细菌感染降低更明显,年龄、有无并发症是影响患者预后的危险因素。
Objective To investigate the causes and risk factors affecting prognosis of infected patients with thrombocytopenia(TP),and to provide assistance in diagnosis,treatment and prevention.Methods Clinical and laboratory data of 203 patients with infectious diseases with thrombocytopenia who were admitted to our hospital from January 2016 to July 2018 were collected,and the causes,pathogens of infection,degree of thrombocytopenia and risk factors related to clinical prognosis were analyzed retrospectively.Results The causes of infection are mainly multi-system infections,respiratory and urinary system infections.The most common pathogens are bacterial infections,followed by viral infections and mixed infections.Common bacteria are Gram-negative bacilli mainly composed of Klebsiella pneumoniae,Escherichia coli and Bowman's complex Acinetobacter aceti.The degree of thrombocytopenia is more common in I degree,and the IV degree is rare.The thrombocytopenia caused by the virus was more obvious than that caused by bacterial infection.The difference was statistically significant(P<0.05).Patients with age ≥ 65 years,with severe underlying disease,complications,and white blood cells ≥ 12× 10~9/L had a poor prognosis compared with patients without the above conditions,and the difference was statistically significant(P <0.05).By logistic regression analysis showed that an independent risk factor for age≥65 years,complications with a poor prognosis for infection with thrombocytopenia.Conclusion Patients with infection-related thrombocytopenia are most common with multi-system infections and bacterial infections,but thrombocytopenia caused by viral infections is more pronounced than bacterial infections.Age and complications are risk factors for prognosis.
Objective To investigate the causes and risk factors affecting prognosis of infected patients with thrombocytopenia(TP),and to provide assistance in diagnosis,treatment and prevention.Methods Clinical and laboratory data of 203 patients with infectious diseases with thrombocytopenia who were admitted to our hospital from January 2016 to July 2018 were collected,and the causes,pathogens of infection,degree of thrombocytopenia and risk factors related to clinical prognosis were analyzed retrospectively.Results The causes of infection are mainly multi-system infections,respiratory and urinary system infections.The most common pathogens are bacterial infections,followed by viral infections and mixed infections.Common bacteria are Gram-negative bacilli mainly composed of Klebsiella pneumoniae,Escherichia coli and Bowman's complex Acinetobacter aceti.The degree of thrombocytopenia is more common in I degree,and the IV degree is rare.The thrombocytopenia caused by the virus was more obvious than that caused by bacterial infection.The difference was statistically significant(P<0.05).Patients with age ≥ 65 years,with severe underlying disease,complications,and white blood cells ≥ 12× 10~9/L had a poor prognosis compared with patients without the above conditions,and the difference was statistically significant(P <0.05).By logistic regression analysis showed that an independent risk factor for age≥65 years,complications with a poor prognosis for infection with thrombocytopenia.Conclusion Patients with infection-related thrombocytopenia are most common with multi-system infections and bacterial infections,but thrombocytopenia caused by viral infections is more pronounced than bacterial infections.Age and complications are risk factors for prognosis.
引文
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[2] MENGXING CHEN,RONG YAN,XIAODONG LI,et al.Akt-mediated platelet apoptosis and its therapeutic implications in immune thrombocytopenia[J].PNAS.2018.
[3] 潘美靖,秦泽鸿,翁锡泉.血小板参数在评估感染相关性血小板减少症预后的价值[J].血栓与止血学,2016,22(01):85-87.
[4] GAERTNER F,AHMAD Z,ROSENBERGER G,et al.Migrating Platelets Are Mechano-scavengers that Collect and Bundle Bacteria[J].Cell 2017;171(6),1368-1382.
[5] 中华人民共和国卫生部.医院感染诊断标准[J].中华医学杂志,2001,81(5):314-320.
[6] National Cancer Intitute.Commom terminology criteria for adverseenvents v3.0(CTCAE)[M].Washington:The Intitute,2006..
[7] 陈珵,徐侃.血小板在炎症反应中作用的研究进展[J].海南医学,2017,28(04):623-626.
[8] INAN OLMEZ,MUHAMMAD ZAFAR,MUHAMMAD SHAHID,et al.Analysis of Significant Decrease in Platelet Count and Thrombocytopenia,Graded According to NCI-CTC,as Prognostic Risk Markers for Mortality and Morbidity[J].Pediatric Hematology Oncol,2011,33(8),585-588.
[9] 袁胜男,赵俊暕,韩晓燕,等.细菌与真菌感染对血小板的影响研究[J].中华医院感染学杂志,2016,26(22):5083-5086.
[10] 马丽萍,魏菁,常建星,等.血小板TLR4表达介导LPS诱导的血小板活化[J].中国实验血液学杂志,2009,17(6):1564-1568.