白念珠菌定植对于免疫抑制宿主继发侵袭性感染的预测价值及免疫调控影响  

The predictive value and immunomodulatory impact of Candida albicans colonization for invasive candidiasis in immunocompromised hosts

作　　者：朱琤[1] 余跃天[2] ZHU Cheng;YU Yuetian(Department of Disease Prevention and Healthcare,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院预防保健科,上海200025 [2]上海交通大学医学院附属仁济医院重症医学科

出　　处：《中国感染与化疗杂志》2022年第5期545-550,共6页Chinese Journal of Infection and Chemotherapy

基　　金：上海市卫健委面上项目(201840006)。

摘　　要：目的探讨免疫抑制宿主白念珠菌定植对于继发侵袭性感染的预测价值及感染发生后宿主的免疫调控与预后相关性。方法前瞻性研究免疫抑制合并白念珠菌血症患者的Sevilla评分、念珠菌定植指数等指标对菌血症的诊断效能,同时连续采集7个时间点Th淋巴细胞绝对值、白细胞介素(IL)-17A等12项指标的变化趋势,分析定植对于念珠菌血症的预测价值及各时间点炎症及免疫指标的变化。结果纳入的42例患者Sevilla评分为(11.1±2.4)分,其与血培养转阴时间呈正相关(R^(2)=0.404,P<0.0001),当Sevilla评分大于11分时,对念珠菌血症具有较好的预测价值(AUC=0.77,P<0.0001)。生存组与死亡组相比,淋巴细胞绝对值及IL-17A等指标可在5~7 d内恢复至稳态水平(P<0.05)。结论Sevilla评分对免疫抑制宿主发生白念珠菌血症具有较高的诊断效能,且其评分高低与血培养转阴时间呈正相关。淋巴细胞绝对值下降及IL-17A持续升高是白念珠菌血症患者预后不良的因素。Objective To investigate the value of Candida albicans colonization for predicting invasive candidiasis in immunocompromised hosts and the effect of immune modulation on outcome.Methods Sevilla score and Candida colonization index were documented in immunocompromised hosts with candidemia.Twelve relevant biomarkers such as Th lymphocyte and interleukin-17A were measured at 7 consecutive time points.The biomarkers were compared to analyze the changing patterns of each marker and the value of Candida albicans colonization for predicting invasive candidiasis.Results A total of 42 patients were included in this study.The average Sevilla score was 11.1±2.4,which was positively correlated with the time to blood culture negative conversion(R^(2)=0.404,P<0.0001).Sevilla score>11 had a better diagnostic value for candidemia(AUC=0.77,P<0.0001).Compared to the deaths group,the absolute lymphocytes count and serum interleukin-17A level could return to the baseline in 5 to 7 days in the survivor group(P<0.05).Conclusions Sevilla score performs well in diagnosing Candida albicans bloodstream infection in immunocompromised host.It is positively correlated with the time to blood culture negative conversion.The decrease of absolute lymphocyte count and consistent increase of serum interleukin-17A are risk factors for poor outcome.

关 键 词：白念珠菌 定植 免疫抑制宿主 侵袭性真菌病 念珠菌血症 

分 类 号：R379.4[医药卫生—病原生物学]