2016 年第 12 期 第 14 卷

乳腺癌化疗后粒细胞减少伴感染患者的特点及降钙素原意义

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关键词：乳腺癌化疗粒细胞减少伴发热降钙素原

• 摘要：
• 【摘要】目的：探讨乳腺癌化疗后粒细胞减少伴发热（FN）合并感染的临床特点及降钙素原在FN合并感染患者中的诊断价值。方法：回顾性分析我院2013年1月至2016年7月粒细胞减少伴发热乳腺癌化疗患者77例，根据临床或病原学诊断为感染组和粒细胞缺乏发热组（非感染组），总结感染患者临床特点，比较两组粒细胞最低值、持续时间、常见化疗方案、降钙素原及C反应蛋白差异。结果：77例FN患者合并感染17例，感染率为22.1%，；感染主要部位为呼吸道、消化道和泌尿道，感染常见病原菌为肺炎克雷伯杆菌、大肠埃希菌、葡萄球菌等。；感染组患者较非感染组患者降钙素原值明显增高，（0.61±0.33 ）ng/mL vs （0.06±0.05）ng/mL，P<0.05，；感染组粒细胞下降持续时间较非感染组延长， （ 6.47±1.13）d vs （5.00±1.16）d，P<0.05；两组粒细胞值、C反应蛋白及化疗方案差异无统计学意义。结论：乳腺癌患者化疗后FN患者感染发生率较高，应加强对化疗后FN患者的规范管理，降钙素原对于乳腺癌化疗后粒细胞减少伴感染有诊断意义，粒细胞减少持续时间长可作为乳腺癌患者化疗后FN合并感染的高危因素。
• ObjectiveTo explore the clinical characteristics of patients in breast cance after chemotherapy–induced febrile neutropenia (FN) and the value of procalcitonin in diagosing febrile neutropenia (FN) .Methods:A total of 77 patients with chemotherapy-induced febrile neutropenia were admitted into the study from January 2013 to July 2016.Those cases were divided into infectious group and control group (febrile neutropenia) according to clinical or etiology features. Sumarizing the characteristics of infectious patients,and comparing the difference between the two groups from neutrophil e granulocytosis level,the duration of granulocytopenia ,common chemotherapy regimens,serum procalcitonin values and C-reactive protein levels. Results:There are 17 cases occurred infection,the incidence rate is 22.1%, and the respiratory tract、digestive tract and urinary tract were the main infection sites. Klebsiella pneumonia,escherichia coli and staphylococcus became the most common pathogene.The procalcitonin in the infection group was significantly higher than the control group(0.61±0.33 ng/ml vs 0.06 ±0.05ng/ml,P<0.05),which has great significant difference between the two groups.Also,the duration decline time of granulocytopenia in infection group is more lengthening than the control group( 6.47±1.13d vs 5.00±1.16d，P<0.05),still,it has significant difference.But the neutrophile granulocytosis level, chemotherapy regimens and the C-reactive protein levels have no statistical difference in two groups. Conclusion :The occurrence rate of infection in breast cancer patients after chemotherapy–induced febrile neutropenia is higher,so we should reinforce the standard management of patients with FN.Second, the procalcitonin has a great significance to the patients with infection in FN.Also, the duration decline time of granulocytopenia should be regard as the high risk factor in breast cancer patients after chemotherapy–induced febrile neutropenia those with infection .