【摘要】 目的 研究骨髓增生异常综合征(MDS)患者接受去甲基化药物(HMA)治疗过程中感染事件的发生率及危险因素。方法 回顾性分析2015年1月—2021年12月在河北医科大学第二医院接受HMA治疗的114例MDS患者的535个HMA治疗周期，采用卡方检验分别对各因素进行单因素分析，选取P<0.1的因素构建广义估计方程(GEE)，探讨感染的危险因素。结果 接受HMA治疗的MDS患者的感染率为46.92%，感染主要发生在呼吸系统；病原菌以革兰阴性菌为主，占66.67%，其中最常见的病原菌为大肠埃希菌。在单因素分析中，合并症数量>2种、住院天数>30 d、不同WHO(2016)分型、每个HMA治疗前ANC<0.5×10~9/L、Hb<80 g/L及PLT<50×10~9/L、前4个HMA治疗周期、不同HMA治疗方案以及既往有化疗史均会增加患者感染的风险(P值均<0.05)。在GEE模型中，合并症数量>2种(OR=8.912)、住院天数>30 d(OR=6.067)、接受地西他滨联合其他药物治疗(OR=3.106)的患者感染率高；每个HMA治疗前Hb≥80 g/L(OR=0.369)、PLT≥50×10~9/L(OR=0.448)的患者以及随着HMA治疗周期的延长(OR=0.909)，感染率逐渐降低(P值均<0.05)。结论 合并症数量>2种、住院天数>30 d的MDS患者在接受HMA治疗的前期，以及治疗过程中Hb<80 g/L、PLT<50×109/L时，感染率较高，尤其是接受地西他滨联合其他药物治疗的患者。更多还原

【Abstract】 Objective To examine the incidence and risk factors of infection events in patients receiving hypomethylating agents(HMAs) to treat myelodysplastic syndrome(MDS).Methods This retrospective study included 535 treatment cycles in 114 MDS patients who were treated with HMAs in the Department of Hematology,the Second Hospital of Hebei Medical University from January 2015 to December 2021.The significant factors were screened out by univariate analysis when Chi-square test showed P <0.1,and used to construct the generalized estimation equation(GEE) to identify the real risk factors of infection.Results The infection rate was 46.92% in the 114 MDS patients treated with HMAs.Most of the infections were respiratory tract infections.Gram-negative bacteria accounted for 66.67%.The most common pathogen was Escherichia coli.Univariate analysis found that number of complications > 2,the length of hospital stay > 30 d,different WHO(2016) MDS classification,and absolute neutrophil count(ANC) < 0.5 × 109/L,Hb < 80 g/L,platelet < 50 × 10~9/L before treatment of each HMAs,cycle 1-4 of HMAs,different HMAs treatment regimens,and prior chemotherapy would increase the risk of infection(P < 0.05).GEE model analysis demonstrated that number of complications > 2(OR = 8.912),the length of hospital stay > 30d(OR = 6.067) and receiving decitabine combined with other drugs(OR = 3.106) contributed to high infection rate,while Hb ≥ 80 g/L(OR = 0.369) and platelet ≥ 50 × 10~9/L(OR = 0.448) before treatment of each HMAs,and prolongation of HMAs treatment cycle(OR=0.909) would decrease the infection rate(P < 0.05).Conclusions The MDS patients who have more than 2 complications,longer than 30 days of hospital stay,Hb < 80 g/L or platelet < 50 × 10~9/L during the early cycles of HMAs treatment will be at higher risk of infection,especially when they are receiving decitabine combined with other drugs.更多还原