The Clinical Study On The Patients With Hematopathy And Neutropenia Complicateed By Infection

Objective:Usually,due to the effect of inflammatory products,neutrophils stored in the bone marrow are released in large quantities,which makes the number of neutrophils in the peripheral blood significantly increase,which is conducive to more neutrophils entering the inflammatory area to play an anti infection role.Because of the own characteristics of hematologic disorder or some infections,and the neutropenia may occur.when the neutrophils in the blood are reduced to 1.00×10~9/L,the resistance of the body is obviously reduced.The patients with hematopathy and neutropenia were taken as the research object,and taken the clinical manifestations,microbial etiology,blood routine,coagulation index and infection related indicators as the research indicators to carry out a more systematic study,and explore the incidence,clinical characteristics and infection influencing factors in the patients with different hematopathy and neutropenia.Method:A total of 161 patients with different hematopathy and neutropenia who were hospitalized in the 967th Hospital of the People's Liberation Army from January 2019 to November 2019 were collected.According to whether infection the pateints were divided into infection groupand non-infection group.The indexes including WBC?NEUT?Hb?PLT?PT?APTT?TT?FIB?e GFR?BUN?Scr?ALB?ALT?AST?hs-CRP?ESR were used as observation indicators for research.Result:1.One hundred and sixty-one patients with hematopathy and neutropenia were included in this group of studies,all of them suffered from the common hematological diseases.2.Among 161 patients with hematopathy and neutropenia,106 patients were complicated by infection,and the incidence of infection was 65.8%;lower and upper respiratory tract infections were most common.A total of 20 pathogenic microorganism strainswere cultured in 106 infected patients,of which 12 strains was gram-negative bacteria,2 Gram-positive bacteria and 6 strains fungi.Among various hematopathy and neutropenia,the incidence of infections,infection sites and pathogenic microorganisms of the patients complicated by infection were different.The incidence of infections from the pateints with AA and MM is highest,which all were 75.0%,and ML is lowest,which was 38.5%;the differences in the incidence of infections among all groups was not statistically significant(P>0.05).Lower respiratory tract infections in the patients with MDS,MM were the most common,accounting for 55.8%and 77.8%repectively;upper respiratory tract infections in the patientswith AA,AL were the most common,accounting for 48.1%and 36.4%respectively;digestive infections are the most common in the patients with ML,which was 60.0%.3.In the blood routine of 106 patients with hematopathy and neutropenia complicated by infection,the comparison of blood routine indexes including median WBC,Hb,and PLT were below the normal reference value.There was statistically significant difference in median WBC from the patients between MDS and MM(P<0.05).There was statistically significant difference in median Hb from the patients between MDS and AA,AL,ML respectively(P<0.05).There was statistically significant difference in median PLT from the patients between AA and MDS,AL,MM,ML repectiely(P<0.05).4.In the coagulation indexes of 106 patients with hematopathy and neutropenia complicated by infection,The median PT,APTT,TT,and FIB were within normal reference values.There was statistically significant difference in median PT from the patients between MDS and AA(P<0.05).Only the median of APTT in the patients with AA,MM was significantly different from that in MDS,ML respetively(P<0.05).5.In the liver function indexes of 106 patients with hematopathy and neutropenia complicated by infection,the median ALT and AST from the patients of MM were below the normal reference vaule range respectively,the other indicators were within the normal reference vaule range.In the renal function indexes of 106 patients with hematopathy and neutropenia complicated by infection,the median e GFR from the patients of MM and AL were below the normal reference value range,the other indexes were within the normal reference value range.6.According to whether infection,161 patients were divided into infected group and non-infected group.The blood routine indicators including WBC,NEUT,Hb,PLT from the patients in the infected group were significantly lower than that in the non-infected group respetively,There was statistically significant difference in average value of WBC,NEUT,Hb,and PLT from the patients between infected group and non-infected group respectively(P<0.05).The median ALB,ALT,and AST from the patients in the infected group were lower than that in the non-infected group respectively.But only there was statistically significant difference in average value of ALB from the patients between infected group and non-infected group(P<0.05).There was no statistically significant difference in median BUN?Scr and e GFR from the patients between infected group and non-infected group respectively(P>0.05).The median hs-CRP from the patients in the infected group was higher than that in the non-infected group.There was statistically significant difference in median hs-CRP from the patients between infected group and non-infected group(P>0.05).7.Multivariate binary logistic regression analysis showed that NEUT?ALB?hs-CRP were independent risk factors for infection.Conclusion:1.The patients with hematopathy and neutropenia is easy to be associated with infection,especially in patients with malignant hematopathy.The patients with AA who are complicated by infection can not be ignored.The common infection site is mainly respiratory tract,and the main pathogen of infection is still Gram-negative bacteria.2.In different hematopathy and neutropenia complicated by infection,WBC,Hb,and PLT from the pateints all were below the normal reference values,which were particularly obvious in MDS,AL,and AA.3.In different hematopathy and neutropenia complicated by infection,the Coagulation indexed including PT,APTT,TT and FIB from the patients are higher or lower they all change within the normal reference vaule range with some difference changes.4.In different hematopathy and neutropenia complicated by infection,the liver enzyme and renal function from the patients with were not significantly abnormal,but the patients from malignant hematopathy including MM,MDS,Al,ML would have different degrees of hypoproteinemia.5.The independent risk factors for co-infection in patients with hematopathy and neutropenia included neutropenia,albumin reduction and increasing high-sensitivity C-reactive protein.