新生儿NICU病房侵袭性真菌感染早期诊断及易感因素研究  

Study on early diagnosis and susceptibility factors of invasive fungal infection in neonatal intensive care unit

作　　者：连炬飞[1] 曾丽[1] 曾文[1] 赖有行[1] 欧阳凯[1] LIAN Jufei;ZENG Li;ZENG Wen;LAI Youxing;OUYANG Kai(Department of Clinical Laboratory,GuangDong Women And Children Hospital,Guangzhou,Guangdong 510010,China)

机构地区：[1]广东省妇幼保健院检验科,广东广州510010

出　　处：《中国优生与遗传杂志》2021年第11期1573-1576,共4页Chinese Journal of Birth Health & Heredity

基　　金：广东省医学科学技术研究基金项目(C2020031)。

摘　　要：目的研究新生儿重症监护病房(NICU)侵袭性真菌感染易感因素和早期诊断措施,探讨其对该病的应用价值。方法回顾性分析2018年1月至2020年8月180例新生儿侵袭性真菌感染的易感因素、基本资料和治疗预后情况,并进行统计学分析。结果500例新生儿重症监护病房患儿接受血培养以及血清β-(1,3)-D-葡聚糖含量检测,其中β-(1,3)-D-葡聚糖阳性患儿180例,阳性率为36.0%;血培养阳性患儿20例,阳性率为4.0%,β-(1,3)-D-葡聚糖检测阳性率明显高于血培养阳性概率(P<0.05)。随着病程进展,β-(1,3)-D-葡聚糖变化差异有统计学意义(P<0.05)。180例侵袭性真菌感染的患儿中病原菌包含念珠菌(37例),白假丝酵母菌(6例),毛霉菌(2例)。180例侵袭性真菌感染的患儿中早产儿110例,气管插管机械通气患儿32例,留置中心静脉导管患儿38例。180例患儿出生体重低于1000 g患儿24例,1000~1500 g患儿120例,大于1500 g患儿36例。结论新生儿重症监护病房侵袭性真菌感染主要人群为早产儿和低重儿,病原菌以念珠菌感染为主,血清β-(1,3)-D-葡聚糖检测对诊断新生儿侵袭性真菌感染有着较高的特异性和灵敏度,在新生儿重症监护病房中开展β-(1,3)-D-葡聚糖检测,可为新生儿侵袭性真菌感染早期诊断提供重要的参考依据,值得推行。Objective To study the susceptibility factors and early diagnostic measures for invasive fungal infection in neonatal intensive care unit, and to explore its application value for the disease. Methods Retrospective analysis was performed on the susceptibility factors, basic data and treatment prognosis of 180 neonates with invasive fungal infection from January 2018 to August 2020, and statistical analysis was performed also. Results Blood culture and serum-(1, 3)-D-glucan content detection were performed in 500 neonatal from intensive care units, among which 180 cases were positive for serum-(1, 3)-D-glucan, with a positive rate of 36.0%. Blood culture was positive in 20 cases, and the positive rate was 4.0%. The positive rate of serum-(1, 3)-D-glucan was significantly higher than the positive rate of blood culture(P<0.05). Serum-(1, 3)-D-glucan has a statistically significant difference with the progression of the disease(P<0.05). Among the 180 cases with invasive fungal infection, the pathogenic bacteria included 37 candida, 6 candida albicans and 2 mucor. Among the 180 cases with invasive fungal infection, 110 were premature, 32 were mechanically ventilated with endotracheal intubation,and 38 were induced with central venous catheter. There were 24 cases with birth weight lower than 1000 g, 120 cases with birth weight between 1000 g and 1500 g, and 36 cases with birth weight greater than 1500 g. Conclusion The main populations of invasive fungal infections in neonatal intensive care units are premature infants and infants with low weight, and the pathogenic bacteria are mainly candida infection. Serum-(1, 3)-D-glucan has high specificity and sensitivity for the diagnosis of invasive fungal infection in neonates. The serum-(1, 3)-D-glucan test in neonatal intensive care unit can provide important reference for the early diagnosis of invasive fungal infection in newborn.

关 键 词：新生儿 侵袭性真菌感染 易感因素 β-(1 3)-D-葡聚糖 早期诊断 

分 类 号：R722.1[医药卫生—儿科]