不同真菌感染危险性评分方法对侵袭性假丝酵母菌感染的早期诊断价值  

Values of different fungal infection risk scoring methods for the early diagnosis of invasive Candidainfection

作　　者：徐明均 徐玉洁[1,2] 张慧婷 李明 张玉洁[1] 孙小鹏 马晓薇 

机构地区：[1]宁夏医科大学,宁夏银川750003 [2]宁夏人类干细胞研究所,宁夏银川750003 [3]宁夏医科大学总医院心脑血管病医院,宁夏银川750012

出　　处：《中国感染控制杂志》2018年第2期141-145,共5页Chinese Journal of Infection Control

基　　金：宁夏医科大学2014年校级科研项目(XT201418);宁夏医科大学临床医学一流学科建设项目(YXW2017014)

摘　　要：目的比较四种真菌评分方法对侵袭性假丝酵母菌感染的诊断价值,为侵袭性假丝酵母菌感染早期诊疗提供依据。方法回顾性分析2011—2016年某院重症监护病房(ICU)收治的侵袭性假丝酵母菌感染高危患者。依据诊断标准将患者分为非感染、拟诊、临床诊断和确诊4组,并对4组患者进行MDRA评分、IFIRSS评分、Sevilla评分及Candida评分,评价四种评分方法对侵袭性假丝酵母菌感染的诊断价值。结果共有275例高危患者,非感染组138例,拟诊组63例,感染组74例(其中临床诊断组64例,确诊组10例)。感染组患者年龄及住院时间均高于非感染组(均P<0.05)。74例感染患者共分离假丝酵母菌74株,主要为白假丝酵母菌60株(81.1%)。MDRA评分阳性114例(41.5%)、Candida评分阳性83例(30.2%)、Sevilla评分阳性42例(15.3%)、IFIRSS评分阳性23例(8.4%)。四种评分方法中MDRA评分灵敏度(Se)较高(59%),但特异度(Sp)最低(66%);IFIRSS评分Sp较高(91%),但Se极低(9%);Sevilla评分Sp最高(96%),Se尚可(45%);Candida评分的Se最高(68%),Sp较高(90%)。结论 Sevilla评分有较高Se和Sp,可用于早期诊断侵袭性假丝酵母菌感染;Candida评分诊断侵袭性假丝酵母菌感染与临床诊断标准总符合率最高,Se、Sp均较高,对侵袭性假丝酵母菌感染早期诊断有较大价值。ObjectiveTo compare diagnostic value of four fungal scoring methods in invasive Candida infection, provide evidence for early diagnosis and treatment of invasive Candida infection. MethodsHighrisk patients with invasive Candida infection in the intensive care unit（ICU） in a hospital from 2011 to 2016 were analyzed retrospectively. According to diagnostic criteria, patients were divided into four groups： noninfection group, suspected infection group, clinically diagnosed group, and confirmed group, patients were conducted multidiseases risk assessment （MDRA） score, invasive fungal infections risk scoring system （IFIRSS ） score, Sevilla score, and Candida score, diagnostic value of four scoring methods for invasive Candida infection were evaluated. ResultsThere were 275 highrisk patients, 138 in noninfection group, 63 in suspected infection group, and 74 in infection group（clinically diagnosed group： n=64; confirmed group： n=10）. The age and length of hospital stay in the infection group were all higher than noninfection group （both P〈0.05）. 74 strains of Candida were isolated from 74 infected patients, mainly Candida albicans （n=60, 81.1%）. Positive rates for MDRA score, Candida score, Sevilla score, and IFIRSS score were 41.5%（n=114）, 30.2%（n=83）, 15.3%（n=42）, and 8.4% （n=23） respectively. Of four MDRA scoring methods, MDRA had the higher sensitivity（Se, 59%） but lowest specificity（Sp, 66%）; IFIRSS had higher Sp（91%） but very low Se （9%）; Sevilla score had the highest Sp （96%）and higher Se（45%） ;Candida score had the highest Se（68%） and higher Sp （90%）. ConclusionSevilla score has higher Se and Sp, which can be used in early diagnosis of invasive Candida infection; Candida score has the highest coincidence with clinical diagnostic criteria for invasive Candida infection, both Se and Sp are high, which is of great value for early diagnosis of invasive Candida infection.

关 键 词：侵袭性假丝酵母菌 评分 诊断 感染 

分 类 号：R379[医药卫生—病原生物学]