早产儿真菌性败血症临床特点及血浆1,3-β-D葡聚糖检测意义  

Clinical characteristics of fungal sepsis in preterm infants and the role of plasma 1,3-β-D glucan measurement

作　　者：郑莉莉[1] 夏红萍[1] 谢利娟[1] 何振娟[1] 张拥军[1] 杨庆南[1] 陈妍[1] 朱天闻[1] 朱建幸[1] 

机构地区：[1]上海交通大学医学院附属新华医院儿内科,200092

出　　处：《中国新生儿科杂志》2011年第5期296-299,共4页Chinese Journal of Neonatology

摘　　要：目的探讨早产儿真菌性败血症临床特点及血浆1，3-β-D葡聚糖检测的意义。方法对2009年3月至2011年2月本院新生儿重症监护病房收治临床怀疑真菌感染的早产儿，应用MB-80微生物动态快速检测系统及GKT-5M真菌1，3-13-D葡聚糖检测试剂盒定量检测血浆1，3-β—D葡聚糖水平，同时进行血常规、c反应蛋白和血培养检测。确诊真菌性败血症的患儿为病例组，未确诊者为对照组。分析早产儿真菌性败血症的，临床特点，比较两组血浆1，3-β-D葡聚糖水平。结果30例疑诊惠儿，病例组14例。病例组中，71．4％（10／14）的真菌性败血症早产儿为极低出生体重儿，血培养均为假丝酵母菌（念珠菌）。临床表现除出现感染症状外，85．7％（12／14）的患儿血小板计数明显下降。42．9％（6／14）的真菌性败血症早产儿合并真菌性脑膜炎。、病例组血浆1，3-β-D葡聚糖水平为181．1（129．6～1009．3）pg／ml，明显高于对照组5．0（5．0～8．8）pg／ml，差异有统计学意义（P〈0．05）。6例合并真菌性脑膜炎患儿血浆1，3-β-D葡聚糖水平为1565．5（183．6～3549．3）pg／ml，8例未合并真菌性脑膜炎患儿的血浆1，3-β-D葡聚糖水平为159．0（48．0～183．7）pg／ml，差异有统计学意义（P〈0．05）。病例组治疗后血浆1，3-β-D葡聚糖较治疗前显著下降，差异有统计学意义（P〈0．05）。结论早产儿真菌性败血症多见于极低出生体重儿，以念珠菌血症多见，多数患儿血小板计数明显下降，易合并真菌性脑膜炎。血浆1，3-β-D葡聚糖对早产儿真菌性败血症的早期诊断、治疗及预后判断有一定意义。Objective To study the clinical characteristics of fungal sepsis in preterm infants and to evaluate the role of plasma 1,3-β-D glucan measurement. Methods Between Mar 2009 and Feb 2011, infants who were suspected to have fungal sepsis in our NICU were enrolled in this study. Plasma 1,3-β-D glucan level was measured by Microbiology Kinetic Rapid Reader MB-80 and GKT-5M kit. Blood routine examination, C Reaction Protein （CRP） and blood culture were also done. The infants were assigned into two groups： group sepsis with fungal sepsis and group control without fungal sepsis. Plasma 1,3-β-D glucan level between different groups were compared. Results Thirty infants were enrolled in the study, fourteen in group sepsis. In group sepsis, 71.4% （10/14）of the infants were very low birth weight infants. All of the cultured fungi were candida. The clinical manifest included the infection signs and the decreased platelet which was found in 85.7% （ 12/14 ） of the infants. 42.9% （6/14） of the infants developed fungal meningitis. The level of 1,3-β-D glucan in group sepsis was 181.1 （ 129.6 - 1009.3） pg/ml,which was significantly higher than that of the control group [5.0（5.0 -8.8）pg/ml） ] （P 〈0.05）. In group sepsis, the level of 1,3-β-D glucan in six infants with fungal meningitis was 1565.5 （183.6 -3549. 3 ） pg/ml, which was significantly higher than that of eight infants without fungal meningitis [ 159.0（45.0 - 183.7） pg/ml] （P 〈0. 05）. The level of 1,3-β-D g]uean in group sepsis decreased significantly after anti-fungal treatment （ P 〈 0. 05 ）. Conclusion Fungal sepsis is mainly seen in very low birth weight infants and eandida is the most common species. Most of the infants have decreased platelet. Many preterm infants with fungal sepsis develop furigal meningitis. The level of 1,3-β-D glucan in plasma can be used to diagnose fungal sepsis and to judge the prognosis in preterm fungal sepsis in NICU.

关 键 词：1  3-β—D葡聚糖 败血症 真菌性 婴儿 早产 

分 类 号：R722.6[医药卫生—儿科]