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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-β-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例疑诊患儿,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 investigate the clinical features of fungal sepsis in preterm infants and the significance of detecting plasma 1,3-β-D-glucan. Methods From March 2009 to February 2011, preterm infants with clinically suspected fungal infection were admitted to neonatal intensive care unit in our hospital. MB-80 microbiological rapid detection system and 1,3-β-D dextran Glucose detection kit quantitative detection of plasma 1,3-β-D-glucan levels, while blood, C-reactive protein and blood culture tests. Children diagnosed with fungal sepsis as the case group, not diagnosed as the control group. The clinical features of fungal sepsis in premature infants were analyzed. The levels of plasma 1,3-β-D-glucan in the two groups were compared. Results 30 cases of suspected children, 14 cases of cases. In the case group, 71.4% (10/14) of preterm infants with fungal septicemia were very low birth weight infants with Candida albicans in blood cultures. Clinical manifestations In addition to the symptoms of infection, 85.7% (12/14) of children with a significant reduction in platelet count. 42.9% (6/14) of fungal septicemia with fungal meningitis. The level of plasma 1,3-β-D-glucan in the case group was 181.1 (129.6 ~ 1009.3) pg / ml, which was significantly higher than that of the control group (5.0 ~ 8.8 pg / . The plasma level of 1,3-β-D-glucan in 6 children with fungal meningitis was 1565.5 (183.6-3549.3) pg / ml. The plasma 1,3-β-D-glucan levels in 8 children with fungal meningitis were not significantly different D glucan level of 159.0 (48.0 ~ 183.7) pg / ml, the difference was statistically significant (P <0.05). The level of plasma 1,3-β-D-glucan in patients after treatment was significantly lower than that before treatment, the difference was statistically significant (P <0.05). Conclusion Fungal sepsis in preterm infants more common in very low birth weight infants, with candida sepsis more common, most children with decreased platelet count, easy to merge fungal meningitis. Plasma 1,3-β-D-glucan plays an important role in the early diagnosis, treatment and prognosis of fungal sepsis in premature infants.