Bow E J, Loewen R, Cheang M S, Schacter B
Department of Medicine, University of Manitoba, Winnipeg, Canada.
Clin Infect Dis. 1995 Aug;21(2):361-9. doi: 10.1093/clinids/21.2.361.
Using multivariate techniques, we studied the relationships of cytotoxic regimen, intestinal mucosal damage, and fungal colonization in the pathogenesis of invasive fungal disease in 138 patients undergoing induction therapy for untreated acute myeloid leukemia (AML) according to three institutional protocols: AML-84 (cytarabine/daunorubicin), AML-87 (high-dose cytarabine/etoposide/daunorubicin), and AML-88 (mitoxantrone/etoposide). Invasive fungal disease occurred in 36%, 6%, and 2.6% of patients participating in protocols AML-87, AML-84, and AML-88, respectively (chi 2 = 23.465; P < .0001). Protocol AML-87 was the strongest independent predictor in the multivariate model (RR = 26.7; P < .0001). Cytotoxic therapy-related epithelial damage in the gut, as measured by D-xylose malabsorption, correlated with invasive fungal disease and protocol AML-87. Fungal colonization, a predictor of invasive fungal disease, correlated with frequent modifications of antibiotic regimens. These results demonstrate the role of cytotoxic regimen-related gut epithelial damage, antibiotic-prescribing behavior, and fungal colonization in the pathogenesis of invasive fungal disease in patients with leukemia.
我们运用多变量技术，依据三项机构方案，对138例接受初治急性髓系白血病（AML）诱导治疗的患者进行研究，分析细胞毒性治疗方案、肠道黏膜损伤及真菌定植在侵袭性真菌病发病机制中的关系。这三项方案分别为：AML - 84（阿糖胞苷/柔红霉素）、AML - 87（大剂量阿糖胞苷/依托泊苷/柔红霉素）和AML - 88（米托蒽醌/依托泊苷）。参与AML - 87、AML - 84和AML - 88方案的患者中，侵袭性真菌病的发生率分别为36%、6%和2.6%（χ² = 23.465；P <.0001）。在多变量模型中，AML - 87方案是最强的独立预测因素（相对风险 = 26.7；P <.0001）。通过D - 木糖吸收测定的与细胞毒性治疗相关的肠道上皮损伤，与侵袭性真菌病及AML - 87方案相关。真菌定植作为侵袭性真菌病的一个预测因素，与频繁更改抗生素治疗方案相关。这些结果表明细胞毒性治疗方案相关的肠道上皮损伤、抗生素处方行为及真菌定植在白血病患者侵袭性真菌病发病机制中的作用。
