新生儿侵袭性真菌感染67例临床分析

Clinical features of invasive fungal infection in 67 neonates

目的探讨新生儿侵袭性真菌感染的临床特点。方法选取2009年1月至2010年12月收治的67例侵袭性真菌感染新生儿病例,分析其病原、高危因素、临床特点、实验室检查及转归情况。结果 67例患儿均为念珠菌属感染,以白色念珠菌感染最为常见,占47.7%,其次为光滑假丝酵母菌,占43.3%;早产儿占所有病例的91.0%,其中50%以上的早产儿胎龄≤32周,9例存在先天性消化道畸形,11例合并有巨细胞病毒感染;25例患儿真菌感染前经外周中心静脉插管(PICC)置管时间≥14 d,16例气管插管机械通气治疗时间>7 d;35例(52.2%)患儿白细胞计数<10×109/L,46例(68.7%)患儿有血小板下降,其中33例持续≥7 d;24例患儿伴有器官受累,包括中枢神经系统、眼及关节;47例(70.1%)经抗真菌治疗后病情好转或治愈,15例(22.4%)患儿死亡。结论新生儿侵袭性真菌感染的病原主要为念珠菌属,尤以白色念珠菌及光滑假丝酵母菌为多见。中枢神经系统、眼及关节为常见受累器官。侵袭性真菌感染的发生、严重程度及转归与患儿的机体状态、原发病及并发症密切相关。

Objective To investigate the clinical features of neonatal invasive fungal infection. Methods The pathogens, risk factors, clinical features, laboratory findings and prognosis were analyzed in 67 neonates with invasive fungal infection during Jan. 2009 to Dec. 2010. Results All 67 cases were infected by Candida. The most common Candida strains were Candida albicans （47.7%） and Candida smooth （43.3%）. The preterm infants accounted for 91% of all cases, among them, more than 50% of cases with the gestational age less than 32 weeks, 9 cases with congenital malformation of digestive system, and 11 cases with cytomegalovirus infection. Before infection, 25 cases accepted PICC with the duration more than or equal to 14 days, and 16 cases accepted the endotracheal intubation and mechani- cal ventilation with the duration more than 7 days, respectively. There were 35 cases （52.2%） with the white blood cell count less than 10× 10^9/L, and 46 patients （68.6%） with thrombocytopenia which was lasted more than or equal 7 days in 33 cases of them. The multi-organ involvement was confirmed in 24 cases including central nervous system, eyes and joints. Forty-seven cases （70.1%） were either improved or cured by anti-fungal treatment, and 15 cases （22.4%） died. Conclusions Candida is the main pathogen of invasive fungal infection in neonates, especially Candi- da albicans and Candida smooth are most common strains of Condida infection. The central nervous system, eyes and joints are common organs to be involved. The occurrence, severity and prognosis of neonatal invasive fungalinfection are closely related with the neonatal body status, original and complicating diseases.