目的 探讨儿童急性白血病(AL)化疗后合并败血症的临床特点及降钙素原(PCT)在判断细菌类别中的作用.方法 2014年6月-2016年6月入住安徽医科大学第二附属医院儿科AL患儿39例,回顾性分析患儿化疗期间合并败血症的的发病因素、感染部位、病原学及不同PCT水平时的细菌类别.结果 39例患儿中急性淋巴细胞白血病28例,急性髓细胞白血病11例.15例患儿有明确感染部位,依次为呼吸道、口腔、肛周及皮肤.病原菌中革兰阳性球菌占53.8％ (21/39),革兰阴性杆菌占43.6％ (17/39),真菌占2.6％ (1/39).中性粒细胞计数＜0.5×109/L时败血症发病率显著提高(P＜0.05).PCT高水平组革兰阴性杆菌检出率高,PCT低水平组革兰阳性球菌检出率高,不同菌种之间PCT水平存在显著性差异(P＜0.01).结论 AL患儿合并败血症与粒细胞计数密切相关;PCT的结果对不同的细菌感染有提示作用,高水平的PCT提示革兰阴性杆菌感染可能性大.%Objective To explore the clinical characteristics of septicemia in pediatric acute leukemia patients after chemotherapy and the roles of procalcitonin in identifying different bacterial species.Methods Clinical and laboratory data from the patients with acute leukemia who had developed septicemia after chemotherapy during the period from June 2014 through June 2016 were retrospectively studied.Results Among all 39 cases,28 cases were diagnosed as acute lymphoblastic Leukemia,and others were diagnosed as acute myelocytic leukemia.Respiratory tract,oralcavity and anal were the most common primary sites of infection.Gram-positive bacteria septicemias were more common than Gram-negative bacteria septicemia(53.8％ vs 43.6％) funal septicemia were in the third place (2.6％).Low absolute neutrophil count isthe risk factor for septicemia development.In patients with high level of PCT,there were more Gram-positive bacteria septicemia than Gram-negative bacteria septicemia,while in patients with low level of PCT,the results were opposite.Conclusions Gram-negative bacteria infections were more common in pediatric patients with acute leukemia after chemotherapy.The absolute neutrophil count is adversely associated with the development of septicemia.Serum PCT concentration is helpful for differential diagnosis of bacterial infection,higher serum PCT level may indicate Gram-negative infection.
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