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目的了解白血病合并热念败血症的临床特征,并探讨影响其预后的相关因素。方法回顾性分析2008—2015年广东省人民医院收治经血培养证实并伴有临床相关症状的热念败血症的白血病患者23例,描述其临床特征、治疗和转归,应用Kaplan-Meier和Cox回归方法分析生存相关预后因素。结果 23例主要临床表现为高热23例(100%),低血压、皮疹各16例(69.6%),咳嗽咳痰12例(52.2%),脾肿大、腹泻各9例(39.1%),肝肿大、关节疼痛各6例(26.1%)等;降钙素原(PCT)正常或轻度升高[0.36(0.12,0.68)μg/L]。初始治疗16例选择唑类药物,其中15例(93.8%)患者因治疗失败,于第5天转换为棘白霉素类药物治疗。中位随访137 d(2~2799 d),治疗有效率为63.6%,粗病死率为65.2%,归因病死率为39.1%,其中第28天归因病死率为88.9%。多因素Cox回归分析显示,降钙素原>3μg/L(β=1.972,95%CI 1.441~35.862,P=0.016)是其归因死亡的独立危险因素;而棘白霉素类药物的应用是独立保护因素(β=-1.999,95%CI 0.030~0.615,P=0.010)。结论尽早应用棘白霉素类药物可能降低白血病合并热念败血症病死率。
Objective To understand the clinical features of leptospirosis complicated with fever and septicemia and explore the related factors that influence its prognosis. Methods A retrospective analysis of 23 cases of lepticemia in Guangdong Provincial People’s Hospital from 2008 to 2015 confirmed by thermal culture and associated with clinically relevant symptoms was performed. The clinical features, treatment and prognosis were described. Kaplan-Meier and Cox regression Analysis of survival related prognostic factors. Results The main clinical manifestations of 23 patients were 23 cases (100%) with fever, 16 cases (69.6%) with hypotension and rash, 12 cases (52.2%) with cough and sputum, 9 cases (39.1%) with splenomegaly and diarrhea, Hepatomegaly, joint pain in 6 cases (26.1%), etc .; normal or mildly elevated procalcitonin (PCT) [0.36 (0.12,0.68) μg / L]. Initial treatment of 16 patients with selected azole drugs, of which 15 cases (93.8%) of patients failed due to treatment, converted to acteiverin treatment on the 5th day. After a median follow-up of 137 days (range, 2 to 2799 days), the effective rate was 63.6%, the crude mortality rate was 65.2%, the attributable mortality rate was 39.1%, and the 28th-day attributable mortality rate was 88.9%. Multivariate Cox regression analysis showed that procalcitonin> 3μg / L (β = 1.972,95% CI 1.441 ~ 35.862, P = 0.016) was an independent risk factor for attributed death; while the application of acteonin Is an independent protective factor (β = -1.999, 95% CI 0.030-0.615, P = 0.010). Conclusion As soon as possible, the application of spiramycin may reduce the mortality of leukemia combined with septicemia.