应用MDRA评分和PCT动态变化诊治侵袭性真菌感染32例临床分析

Clinical Analysis of 32 Patients with Invasive Fungal Infection Diagnosed and Treated by Used of MDRA Score and PCT Dynamic Changes

目的:探讨联合MDRA评分和PCT动态变化对诊治侵袭性真菌感染(IFI)成功率的影响。方法:回顾性分析2013年4月-2014年4月重症监护病房(ICU)收治的真菌感染患者32例的临床资料,利用美国西弗吉尼亚大学医学院建立的真菌感染危险因素评分系统(Multi-disease Risk Assessment Program,MDRA)评分标准进行评分,观察MDRA评分和PCT动态变化对诊治侵袭性真菌感染的价值。结果:32例真菌感染患者的MDRA评分均>30分,符合经验治疗的标准,但PCT值轻度升高并处于低水平及动态检测发现PCT值进行性降低的病例抗真菌治疗有效,而PCT值高,及进行性升高的病例抗真菌治疗无效。结论:侵袭性真菌感染的诊治不能教条地照搬MDRA评分标准,结合PCT的动态检测值水平有助于提高诊治的正确率。

Objective：To explore the effect on the success rate of diagnosis and treatment of invasive fungal infections by MDRA score and the dynamic changes of PCT. Methods： The clinical data of 32 patients with fungal infection in ICU from Apr 2013 to Apt 2014 were retrospectively analyzed, and the American west virginia university school of medicine were used to establish the fungal infection risk factor scoring system （Multi - diseases Risk Assessment Program, MDRA） rating criteria. The value of MDRA score and the dynamic change of PCT in diagnosis and treatment of invasive fungal infections were observed. Results： The MDRA scores in the 32 cases were greater than 30 score and accorded with the standard of experiential therapy. The effective of antifungal therapy was in the cases with lower PCT value,and ineffective of antifungal treatment was in the cases with higher PCT value. Conclusion：It cannot dogmatic copy the MDRA score standard to diagnosis and treatment the invasive fungal infections, and combine with dynamic PCT level may improve the correct rate of the diagnosis and treatment.