儿童重症监护室侵袭性真菌感染的特点及血浆1,3-B-D葡聚糖检测的临床价值

The clinical features of invasive fungal infection in pediatric intensive care unit and the diagnostic value of plasma 1,3-β-D-glucan

目的探讨儿童重症监护室(PICU)侵袭性真菌感染的临床特点和血浆1,3-B-D葡聚糖检测(G实验)的临床价值。方法收集2012年1月至2018年1月我院PICU收治的行G实验检查的患儿169例,调查发生侵袭性真菌感染(IFI)的特点,比较排除IFI组G实验结果和IFI组G实验结果,治疗前后IFI组的G实验结果,比较不同阳性值G试验诊断患儿IFI的敏感度和特异度(%),绘制G试验诊断IFI的ROC曲线。结果中心静脉置管、接受过>7天广谱抗生素治疗及有创机械通气治疗,接受糖皮质激素治疗,较长时间使用胃肠外营养(TPN)为可能导致侵袭性真菌感染的高危因素;诊断IFI组G实验结果显著高于排除IFI组,治疗7天后IFI组的G实验结果显著低于治疗前,使用20 pg/ml作为G实验的阳性界值,灵敏度0.96,特异度0.75,ROC曲线下面积为0.882,P=0.00,95%CI(0.757,1.000)。结论接受侵袭性操作、较长时间广谱抗生素和激素治疗的患儿是PICU侵袭性真菌感染的特点;血浆1,3-B-D葡聚糖检测是早期诊断IFI的有效检测手段之一,使用20pg/ml作为G实验的阳性界值,可以获得较满意的灵敏度和特异度。

Objective To investigate the clinical features of invasive fungal infection （IFI） in pediatric intensive care unit （PICU） and the clinical value of plasma 1,3-p-D-glucan （G test）.Methods We collected the data of 169 hospitalized patients who underwent the G test in our hospital from January 2012 to February 2018 to analyzethe clinical features of IFI.The results of the G test between IFI group and non-IFI group as well as the results between pre- and post-treatment in the Wl group were compared.The sensi-tivity and specificity of IFI with different positive G test value were compared and then, the ROC curve was drawn for diagnosis of IFI by using the G test.Results We found that the central venous indwelling catheter, more than 7 days administration of broad spectrum an-tibiotics ,mechanical ventilation, glucocorticoids treatment and long course of TPN were the possible high risks for IFI.The value of the G test in the IFI group was higher than in the non-IFI group.After 7 days treatment, the value of the G test was lower than before treat-ment.If 20pg/ml was used as the cut-off value of the G test,the sensitivity was0.96 and the specificity was0.75.The area under ROC was0.880 with P=0.00,95% Cl=0.757-1.000）.Conclusion Invasive treatment, long term administration of broad spectrum anti-biotics and glucocorticoids treatment are the clinical features of IFI.The G test is the effective method for early diagnose of IFI.Using 20pg/ml as the cut-off value may achieve good sensitivity and specificity.