念珠菌血症与癌症：患者并非完全相同。
Candidaemia and cancer: patients are not all the same.
作者信息
Pasqualotto Alessandro Comarú, Rosa Daniela Dornelles, Medeiros Lidia Rosi, Severo Luiz Carlos
机构信息
Medical School, The University of Manchester, UK.
出版信息
BMC Infect Dis. 2006 Mar 16;6:50. doi: 10.1186/1471-2334-6-50.
BACKGROUND
Most of the studies about invasive Candida infections in cancer patients have focused on haematological patients. The aim of this study was to provide information about risk factors for candidaemia in patients with solid tumours.
METHODS
Retrospective cohort study. During a 9-year period (1995-2003) we reviewed all cases of candidaemia that affected cancer patients in Santa Casa Complexo Hospitalar, Brazil.
RESULTS
During the period of study, 210 patients had the diagnosis of candidaemia in our medical centre, and 83 of these patients had cancer (39.5%). The majority of patients with cancer had solid tumours (77.1%), mostly in the alimentary tract. Most of solid cancers were non-metastatic (71.9%). Major diagnoses in patients with haematological neoplasia were acute leukaemia (n = 13), high grade non-Hodgkin lymphoma (n = 5) and Hodgkin's disease (n = 1). Non-Candida albicans species caused 57.8% of the episodes of candidaemia in patients with cancer, mainly in patients with haematological malignancies (p = 0.034). Neutropenia and treatment with corticosteroids were more frequent in the haematological group, in comparison with patients with solid tumours. Only 22.2% of patients with solid tumours were neutropenic before candidaemia. Nonetheless, the presence of ileus and the use of anaerobicides were independent risk factors for candidaemia in patients with solid cancers. The overall mortality in cancer patients with candidaemia was 49.4%. We then compared 2 groups of adult patients with candidaemia. The first was composed of non-neutropenic patients with solid tumours, and the second group included patients without cancer. We found that central venous catheters and gastrointestinal surgery were independently associated with candidaemia in patients with solid tumour.
CONCLUSION
Cancer patients with candidaemia seem to have very different predisposing factors to acquire the infection when stratified according to baseline diseases. This study provides some useful clinical information regarding risk for candidaemia in patients with solid tumours.
背景
大多数关于癌症患者侵袭性念珠菌感染的研究都集中在血液系统疾病患者。本研究的目的是提供实体瘤患者念珠菌血症危险因素的相关信息。
方法
回顾性队列研究。在9年期间（1995 - 2003年），我们回顾了巴西圣卡塔琳娜综合医院所有影响癌症患者的念珠菌血症病例。
结果
在研究期间，我们医疗中心有210例患者被诊断为念珠菌血症，其中83例患有癌症（39.5%）。大多数癌症患者患有实体瘤（77.1%），主要位于消化道。大多数实体癌为非转移性（71.9%）。血液系统肿瘤患者的主要诊断为急性白血病（n = 13）、高级别非霍奇金淋巴瘤（n = 5）和霍奇金病（n = 1）。非白色念珠菌属导致癌症患者57.8%的念珠菌血症发作，主要见于血液系统恶性肿瘤患者（p = 0.034）。与实体瘤患者相比，血液系统疾病组中性粒细胞减少症和使用皮质类固醇更为常见。实体瘤患者在念珠菌血症发生前仅有22.2%为中性粒细胞减少。尽管如此，肠梗阻的存在和使用厌氧菌是实体癌患者念珠菌血症的独立危险因素。癌症合并念珠菌血症患者的总体死亡率为49.4%。然后我们比较了两组成年念珠菌血症患者。第一组由非中性粒细胞减少的实体瘤患者组成，第二组包括无癌症患者。我们发现中心静脉导管和胃肠道手术与实体瘤患者的念珠菌血症独立相关。
结论
根据基础疾病分层时，癌症合并念珠菌血症患者获得感染的易感因素似乎有很大不同。本研究提供了一些关于实体瘤患者念珠菌血症风险的有用临床信息。
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