Bishop J F, Schimpff S C, Diggs C H, Wiernik P H
Ann Intern Med. 1981 Nov;95(5):549-55. doi: 10.7326/0003-4819-95-5-549.
Records of 133 infections occurring in 73 of 125 patients with late-stage non-Hodgkin's lymphoma on intensive chemotherapy programs for a median of 23 months were reviewed. Granulocytopenia, usually related to chemotherapy, was the major predisposing factor, association with 51% of infections. The incidence of infection in chemotherapy courses associated with less than 500 granulocytes/microL was higher than those with 500 or more granulocytes/microL (p = 0.0004). Splenectomized patients tended to have a higher incidence of chemotherapy courses with an infection (p = 0.06); marrow involvement was not a significant predisposing factor to infection. The commonest sites of infection were lung, skin, and alimentary canal. Gram-negative organisms and Staphylococcus aureus caused 83% of documented infections; Pseudomonas aeruginosa was the major cause of pneumonia and bacteremia; and herpes zoster and fungi each caused only 3% of infections. Other infections associated with impaired cellular or humoral immunity were uncommon. Poor prognosis was associated with infections in granulocytopenic patients with stable or falling granulocyte counts, infection at multiple sites, and bacteremia, especially polymicrobial bacteremia.
回顾了125例晚期非霍奇金淋巴瘤患者中73例患者发生的133次感染记录，这些患者接受强化化疗方案的中位时间为23个月。粒细胞减少通常与化疗有关，是主要的易感因素，与51%的感染相关。化疗疗程中粒细胞计数低于500/微升的患者感染发生率高于粒细胞计数为500/微升或更高的患者（p = 0.0004）。脾切除患者化疗疗程中发生感染的发生率往往较高（p = 0.06）；骨髓受累不是感染的重要易感因素。最常见的感染部位是肺、皮肤和消化道。革兰氏阴性菌和金黄色葡萄球菌导致83%的有记录感染；铜绿假单胞菌是肺炎和菌血症的主要原因；带状疱疹和真菌各仅导致3%的感染。其他与细胞或体液免疫受损相关的感染并不常见。预后不良与粒细胞减少且粒细胞计数稳定或下降的患者发生感染、多部位感染和菌血症，尤其是多微生物菌血症有关。
