[免疫功能受损：风险群体及对全科医疗的影响]

[Impaired immunity: risk groups and consequences for general practice].

作者信息

Opstelten W, Bijlsma J W J, Gelinck L B S, Hielkema C M J, Verheij Th J M, van Eden W

机构信息

Nederlands Huisartsen Genootschap, Utrecht.

出版信息

Ned Tijdschr Geneeskd. 2016;160:A9752.

Abstract

Due to medication use, comorbidities and/or age, an increasing number of patients have an impaired immunity to infection.- Impaired immunity may lead to an increased risk of (opportunistic) infection, complications from infections, and difficulties in the diagnosis of infections.- Guided by clinical parameters, a general practitioner can classify an impaired immunity as 'clinically irrelevant', 'limitedly relevant' or 'potentially serious'.- Tocilizumab impairs the production of CRP, which makes it unreliable as an infection parameter.- In case of a suspected infection in patients with severe immunosuppression, it will often be necessary to consult a specialist as quickly as possible about further diagnostic procedures and the need for, type and administration route of antimicrobials.- In patients with an impaired immunity, adaptation of the antibiotic policy and prophylactic measures, such as vaccination, may be indicated.- Patients with (functional) asplenia should immediately start antibiotic treatment in case of fever, pending clinical evaluation by a physician.

摘要

由于药物使用、合并症和/或年龄因素，越来越多的患者对感染的免疫力受损。
免疫功能受损可能导致（机会性）感染风险增加、感染并发症以及感染诊断困难。
在临床参数的指导下，全科医生可将免疫功能受损分类为“临床无关”、“相关性有限”或“潜在严重”。
托珠单抗会影响CRP的产生，这使得它作为感染参数不可靠。
对于严重免疫抑制患者怀疑感染的情况，通常有必要尽快就进一步的诊断程序以及抗菌药物的需求、类型和给药途径咨询专科医生。
对于免疫功能受损的患者，可能需要调整抗生素政策和采取预防措施，如接种疫苗。
（功能性）无脾患者发热时应立即开始抗生素治疗，等待医生进行临床评估。