Coker D D, Morris D M, Coleman J J, Schimpff S C, Wiernik P H, Elias E G
Am J Med. 1983 Jul;75(1):97-109. doi: 10.1016/0002-9343(83)91173-7.
To determine the incidence and types of infections in Hodgkin's disease, particularly those related to the overwhelming pneumococcal sepsis syndrome, 210 consecutive patients with previously untreated Hodgkin's disease who underwent staging laparotomy with splenectomy from March 1968 to October 1979 were reviewed. For 178 patients (85 percent) alive at the end of the study, the mean follow-up time was 68.1 months. Eighty-two serious infections occurred among 59 (28 percent) of the patients; 47 (57 percent) serious infections were microbiologically documented and 35 (43 percent) were clinically documented. Forty-seven microbiologically documented serious infections occurred in 34 patients and consisted of 23 episodes of pneumonia, 10 cases of bacteremia, seven wound infections, two cases of disseminated herpes zoster, one subphrenic abscess, and four miscellaneous infections. Microbiologically documented serious infections occurring during initial treatment or remission had lower incidences of leukopenia (29 versus 58 percent) (p = 0.09) and death (11 versus 53 percent) (p = 0.005) than those occurring after relapse of Hodgkin's disease. Of the microbiologically documented serious infections, 76 percent were associated with a predisposing factor(s) (leukopenia, postoperative state, steroids, peripheral neuropathy, leukemia), of which 34 percent were fatal. Microbiologically documented serious infections unassociated with a predisposing factor were never fatal, including the only episode of pneumococcal sepsis in the series. In contrast to microbiologically documented serious infections, only 14 percent of clinically documented serious infections (versus 38 percent) were fatal. The overwhelming pneumococcal sepsis syndrome and other infections thought to be associated with the asplenic state are uncommon problems in patients with Hodgkin's disease after splenectomy.
为了确定霍奇金淋巴瘤患者感染的发生率及类型，尤其是与暴发性肺炎球菌败血症综合征相关的感染，我们回顾了1968年3月至1979年10月期间连续210例未经治疗的霍奇金淋巴瘤患者，这些患者接受了分期剖腹探查术并切除脾脏。在研究结束时，178例（85%）患者存活，平均随访时间为68.1个月。59例（28%）患者发生了82次严重感染；47次（57%）严重感染有微生物学记录，35次（43%）为临床记录。34例患者发生了47次有微生物学记录的严重感染，包括23例肺炎、10例菌血症、7例伤口感染、2例播散性带状疱疹、1例膈下脓肿和4例其他感染。初始治疗或缓解期发生的有微生物学记录的严重感染，白细胞减少症发生率（29%对58%）（p = 0.09）和死亡率（11%对53%）（p = 0.005）低于霍奇金淋巴瘤复发后发生的此类感染。在有微生物学记录的严重感染中，76%与一个或多个易感因素（白细胞减少症、术后状态、类固醇、周围神经病变、白血病）相关，其中34%是致命的。与易感因素无关的有微生物学记录的严重感染从未致命，包括该系列中唯一的肺炎球菌败血症病例。与有微生物学记录的严重感染相比，临床记录的严重感染中只有14%（对38%）是致命的。暴发性肺炎球菌败血症综合征和其他被认为与无脾状态相关的感染在霍奇金淋巴瘤患者脾切除术后是不常见的问题。
