【摘要】 目的分析非霍奇金淋巴瘤（NHL）患者化疗后并发肺部感染的免疫学特点及病原菌分布情况,探讨抗菌治疗的最佳方案。方法选取2015年2月-2017年2月于医院行NHL化疗并发肺部感染的40例患者为研究组,另在同期接受化疗但未出现肺部感染的患者中随机选择40例患者为对照组。分析患者IgA、IgG、IgM等体液免疫指标和CD₃⁺、CD₄⁺、CD₈+及CD₄/CD₈比值等细胞免疫指标的机体免疫学特点,分析NHL并发肺部感染患者化疗后痰培养病原菌分布及耐药性。结果 NHL并发肺部感染患者,其体液免疫指标IgA、IgG、IgM随着感染程度的加重而逐渐降低（P<0.05）,中度和重度感染患者细胞免疫指标CD₃⁺、CD₄⁺、CD₈+及CD₄/CD₈低于轻度感染患者（P<0.05）;研究组患者IgA、IgG、IgM均低于对照组患者（P<0.05）;研究组患者CD₃⁺、CD₄⁺、CD₈+和CD₄/CD₈比值优于对照组患者（P<0.05）;感染患者痰培养共培养出病原菌63株,其中革兰阴性菌46株占73.02%、革兰阳性菌11株占17.46%、真菌6株占9.52%;肺炎克雷伯菌对头孢吡肟、头孢曲松和氨苄青霉素耐药株数较多,铜绿假单胞菌对头孢吡肟耐药株数较多。结论 NHL化疗后肺部感染引起免疫指标发生变化,降低机体抗感染能力,诱发病原菌滋生并增强对抗菌药物耐药性。在临床诊疗过程中,结合实际情况采用联合敏感抗菌药物综合治疗。更多还原

【Abstract】 OBJECTIVE To analyze the immunological characteristics and distribution of pathogenic bacteria in patients of non Hodgkin lymphoma（NHL）complicated with pulmonary infection after chemotherapy,and explore the best solution for antiseptic therapy.METHODS A total of 40 cases of patients with pulmonary infection who received chemotherapy for non-Hodgkin lymphoma in our hospital from Feb.2015 to Feb.2017 were selected as the study group,and 40 patients who received chemotherapy without pulmonary infection were selected as the control group.The immunological characteristics of humoral immune indexes of IgA,IgG and IgM,and other cellular immune indexes of CD₃⁺,CD₄⁺,CD₈⁺and CD4/CD₈ ratio of patients were analyzed.The distribution and drug resistance of pathogenic bacteria in sputum culture of patients with NHL after pulmonary infection were analyzed.RESULTS With the degree of infection deepened,IgA,IgG,IgM and other humoral immune indicators decreased in patients with NHL chemotherapy complicated with pulmonary infection（P<0.05）.The cellular immune indexes of CD₃⁺,CD₄⁺,CD₈⁺and CD4/CD₈ ratio of patients with moderate and severe infection were lower than those with mild infection（P<0.05）.The IgA,IgG and IgM of the study group were lower than those of the control group（P<0.05）,and the CD₃⁺,CD₄⁺,CD₈⁺and CD4/CD₈ ratio of the study group were better than those of the control group（P<0.05）.Totally 63 strains of pathogenic bacteria were cultivated in the sputum culture of the infected patients,of which 46 strains were gram-negative bacteria,accounting for 73.02%,11 strains were gram-positive bacteria,accounting for 17.46%,and 6 strains were fungi,accounting for 9.52%.Klebsiella pneumoniae had more resistance to cefepime,ceftriaxone and ampicillin,and Pseudomonas aeruginosa had more resistance to cefepime.CONCLUSIONThe immune indexes change in patients with pulmonary infection after NHL’s chemotherapy,reducing the body’s resistance to infection,inducing breeding bacteria and enhancing the antibacterial drug resistance.In the clinical diagnosis and treatment process,we should use combined sensitive antibiotics for comprehensive treatment combined with the actual situations.更多还原