儿童肾病综合征并发侵袭性真菌感染危险因素及血清PCT和CRP水平  

Risk factors for invasive fungal infection and serum PCT and CRP in children with nephrotic syndrome

作　　者：邢二庆 王成祥[1] 尚家星 常绍鸿[1] 原超[3] 刘玉霞[1] XING Er-qing;WANG Cheng-xiang;SHANG Jia-xing;CHANG Shao-hong;YUAN Chao;LIU Yu-xia(Xinxiang Central Hospital,Xinxiang,Henan 453000,China)

机构地区：[1]新乡市中心医院儿一科,河南新乡453000 [2]新乡市中心医院特需三,河南新乡453000 [3]新乡市中心医院NICU,河南新乡453000

出　　处：《中华医院感染学杂志》2021年第13期1987-1991,共5页Chinese Journal of Nosocomiology

基　　金：中华国际科学交流基金会基金资助项目(Z2019LHNB002)。

摘　　要：目的分析儿童肾病综合征(NS)并发侵袭性真菌感染(IFI)的危险因素及血清降钙素原(PCT)和C-反应蛋白(CRP)水平。方法回顾性分析2017年9月-2019年9月在新乡市中心医院就诊的247例NS患儿,根据患儿治疗期间是否发生IFI感染,分为感染组46例和未感染组201例。无菌采集患儿感染部位样本进行真菌培养。分析两组患儿年龄、肾病类型、住院时间、血清白蛋白(ALB)、免疫球蛋白A(IgA)、IgG水平;分别于治疗前、治疗2周后,检测血白细胞(WBC)、血清白细胞介素-6(IL-6)、CRP、PCT水平;受试者工作特征曲线(ROC)分析血WBC、IL-6、PCT和CRP预测IFI的价值,Logistic模型分析影响IFI的危险因素。结果247例NS患儿IFI感染率为18.62%,分离真菌为假丝酵母(91.30%)和曲霉菌(8.70%);年龄<3岁(OR=1.881,P=0.027)、ALB<20 g/L(OR=1.815,P=0.043)、住院时间≥30 d(OR=1.937,P=0.016)均为影响IFI的独立危险因素;血WBC、IL-6、PCT和CRP预测IFI的曲线下面积(AUC)分别为0.650、0.708、0.762、0.733(P<0.05),联合检测预测IFI的AUC为0.909(P<0.05);NS并发IFI患儿治疗后的血WBC、IL-6、PCT和CRP水平均低于治疗前(P<0.05)。结论年龄<3岁、血清ALB<20 g/L和住院时间≥30 d是影响NS患儿并发IFI的独立危险因素,临床可根据血清PCT和CRP水平,评估IFI的发生发展,指导临床治疗。OBJECTIVE To analyze the risk factors for invasive fungal infection(IFI)in the children with nephrotic syndrome(NS)and observe the levels of serum procalcitonin(PCT)and C-reactive protein(CRP).METHODS A total of children with NS who were treated in the Xinxiang Central Hospital from Sep 2017 to Sep 2019 were retrospectively analyzed and were divided into the infection group with 46 cases and the non-infection group with 201 cases according to the status of IFI infection during treatment period.The samples were collected from the infection sites of the children so as to carry out the fungal culture.The age,type of kidney disease,length of hospital stay,and levels of serum albumin(ALB),immunoglobulin A(IgA)and IgG were observed.The levels of serum white blood cell(WBC),interleukin-6(IL-6),CRP and PCT were detected before the treatment and after the treatment for 2 weeks.The value of serum WBC,IL-6,PCT and CRP in prediction of IFI was analyzed by means of receiver operating characteristic(ROC)curve,and logistic model analysis was performed for risk factors for IFI.RESULTS Among the 247 children with NS,the incidence rate of IFI was 18.62%.Among the isolated fungi,91.30%were Candida,and 8.70%were Aspergillus.The less than 3 years of age(OR=1.881,P=0.027),ALB less than 20 g/L(OR=1.815,P=0.043)and length of hospital stay no less than 30 days(OR=1.937,P=0.016)were the independent risk factors for IFI.The areas under curve(AUCs)of serum WBC,IL-6,PCT and CRP were respectively 0.650,0.708,0.762 and 0.733 in prediction of IFI(P<0.05),the AUC of joint detection of the above indexes was 0.909 in prediction of IFI(P<0.05).The levels of serum WBC,IL-6,PCT and CRP of the NS children complicated with IFI were significantly lower after the treatment than before the treatment(P<0.05).CONCLUSION The less than 3 years of age,serum ALB less than 20 g/L and length of hospital stay no less than 30 days are the independent risk factors for IFI in the children with NS.The clinicians can assess the progression of IFI and guide the clinical

关 键 词：肾病综合征 侵袭性真菌感染 危险因素 降钙素原 C-反应蛋白 

分 类 号：R692[医药卫生—泌尿科学]