Pomeroy C, Oken M M, Rydell R E, Filice G A
Infectious Disease Section, Veterans Affairs Medical Center, Minneapolis, Minnesota 55417.
Am J Med. 1991 Mar;90(3):338-44.
To determine the incidence, characteristics, and outcome of infection in patients with myelodysplastic syndromes (MDS) and risk factors that may lead to infection.
We reviewed infections that occurred in 86 consecutive patients with MDS who received care from 1968 to 1986 at a university-affiliated Veterans Affairs Medical Center. Time lines charting the course of each patient with MDS were created and included infections, MDS subgroup at the time of presentation and at the time of each infection, peripheral neutrophil counts, and therapies for MDS.
Infections occurred at a rate of nearly one per patient year of observation. Infection rates were associated with MDS subgroup as follows: refractory anemia with or without ringed sideroblasts (RA +/- RS) less than refractory anemia with excess blasts (RAEB) less than RAEB in transformation (RAEB-T). The group of RA +/- RS patients who had erythroid abnormalities but minimal or no dyspoiesis of other cell lines had the lowest rate of infections. Infection rates were higher in patients with less than or equal to 1,000 neutrophils/microL blood than in patients with greater than 1,000 neutrophils/microL blood for each classifiable MDS subgroup. Neutrophil concentration and MDS subgroup were independent risk factors for infection in patients with MDS. Bacterial pneumonias and skin abscesses were the most common infections. Infection was the most common cause of death during MDS, accounting for 64% of deaths, and was more common than transformation to acute leukemia as a cause of death.
Infection is a common, life-threatening problem in patients with MDS. Neutropenia and MDS subgroup are each risk factors for infection. Clinicians should aggressively evaluate patients with fever and MDS for infection, especially pneumonia and skin infections.
确定骨髓增生异常综合征（MDS）患者感染的发生率、特征及转归，以及可能导致感染的危险因素。
我们回顾了1968年至1986年在一所大学附属退伍军人事务医疗中心接受治疗的86例连续性MDS患者发生的感染情况。绘制了每位MDS患者病程的时间线，包括感染情况、初诊时及每次感染时的MDS亚组、外周血中性粒细胞计数以及MDS的治疗方法。
感染发生率接近每位患者每年1次。感染率与MDS亚组相关，具体如下：伴有或不伴有环形铁粒幼细胞的难治性贫血（RA +/- RS）低于伴有过多原始细胞的难治性贫血（RAEB）低于转化中的RAEB（RAEB-T）。红细胞异常但其他细胞系极少或无发育异常的RA +/- RS患者组感染率最低。对于每个可分类的MDS亚组，外周血中性粒细胞≤1000/μL的患者感染率高于中性粒细胞＞1000/μL的患者。中性粒细胞浓度和MDS亚组是MDS患者感染的独立危险因素。细菌性肺炎和皮肤脓肿是最常见的感染类型。感染是MDS患者最常见的死亡原因，占死亡病例的64%，作为死亡原因比转化为急性白血病更常见。
感染是MDS患者常见的、危及生命的问题。中性粒细胞减少和MDS亚组均为感染的危险因素。临床医生应积极评估发热的MDS患者是否存在感染，尤其是肺炎和皮肤感染。
