Clinical Analysis Of Multiple Myeloma With Infection

Background and ObjectiveMultiple Myeloma(MM)is a heterogeneous disease of the blood system,presenting with different subtypes and prognosis.Age,tumor burden,biological property and response to treatment can all have an impact on patient's outcome.Malignant plasma cells gather in the bone marrow,abnormal immunoglobulins are produced by these cells,and abnormal immunoglobulin does not participate in the immune response and suppresses the adaptive immune system,which is the most remarkable pathophysiological peculiarity of MM.Infection is an crucial syndrome of MM.Infection may be the first symptom of MM or occur during treatment.Infection is mainly bacillosis,and viral infection can take place during treatment,which is obviously related to the mortality of patients.In this study,the infection site,pathogens,immune function,and infection-related risk factors of MM patients co-infection were analyzed to improve the recognition of MM co-infection,explore measures that can effectively reduce the incidence of infection,reduce this potentially fatal complication,and improve the prognosis.MethodsA retrospective analysis was conducted to screen 251 patients with multiple myeloma admitted to the people's hospital of zhengzhou university from November 2016 to August 2018 according to the guidelines of the National Comprehensive Cancer Network and the International Myeloma Working Group.The patients were divided into the infected group and the uninfected group according to the incidence of infection.Clinical data of patients were collected,general data,laboratory biochemical test and other related data of the two groups were compared and analyzed,and SPSS 22.0 software was used for statistical analysis to analyze the characteristics of infection,immune function and independent risk factors of co-infection.Results1.251 patients were selected,118 had infection(47.0%),lung infection(41.5%)and urinary tract infection(22.1%)had high incidence,among which 17 had unknown infection sites.Microorganisms were isolated from the body fluids or/and blood of 72 patients,and the top three pathogenic bacteria were staphylococcus aureus 17 cases(23.6%),escherichia coli 16 cases(22.2%),and Streptococcus pneumoniae 10 cases(13.9%).Infection was the first symptom of 38 patients,18 of whom isolated the pathogenic bacteria,including 10 cases of streptococcus pneumoniae(55.5%),6 cases of escherichia coli(33.3%),1 case of pseudomonas aeruginosa(5.6%),and 1 case of staphylococcus aureus(5.6%).2.59 patients has carried on the determination of lymphocyte subsets,23 cases of uninfected group,group of 36 cases of infection,through independent sample r.test analysis,infection of CD4+T cell covnt and CD4+/CD8+ratio,B lymphocyte count were lower than uninfected group,and has obvious statistical significance(P<0.05),infected and uninfected group NK cell count,CD8+T lymphocyte count there was no statistically significant difference(P>0.05).3,X2 test results showed that there was no significant difference in the incidence of infection between male and female MM patients,between different disease types also made the same result(P>0.05).MM patients had a higher risk of infection under the conditions of advanced age,multiple times of chemotherapy,long hospital stay,high PS score,neUtropenia,low hemoglobin,low albumin,high globulin,high ?2 microglobulin,high blood calcium,Poor blood glucose control,and impaired renal function(P<0.05).4.Logistic regression analysis suggested that the independent risk factors for infection in MM patients included high PS score,frequent chemotherapy,hypoproteinemia,anemia,neutropenia,and high ?2 microglobulin level(P<0.05).Conclusion1.The incidence of MM infection is high,mainly in the lung and urinary tract,streptococcus pneumoniae is the most common pathogen in recently diagnosed and never treated patients,then there is escherichia coli,while staphylococcus aureus and gram-negative bacteria are the main pathogens that infect most hospitalized and/or post-chemotherapy patients.2.The main manifestations of immune dysfunction in MM patients with co-infection were reduced CD4+T lymphocytes and B lymphocytes.3.Patients with poor lymphocyte immunity are more susceptible to infection,poor physical activity status,long time and multi-cycle chemotherapy,poor nutritional status,myelosuppression and high tumor load were independent positive correlation factors for the increased incidence of infection in patients with multiple myeloma.