不同免疫状态患者念珠菌血症的实验室检测特征分析

Laboratory characteristics of candidemia in terms of immune status of patients

目的探讨不同免疫状态患者念珠菌血症的病原菌分布及药敏、血清标志物等实验室检验指标的差异。方法回顾性收集分析2016年1月-2018年12月重庆医科大学附属第一医院念珠菌血症患者的临床和实验室相关资料。结果103例患者纳入分析,免疫抑制组58例,非免疫抑制组45例。非免疫抑制组接受体内导管置入和完全肠外营养的比例明显高于免疫抑制组;微生物学特征显示免疫抑制组的热带念珠菌分离率明显高于非免疫抑制组,非免疫抑制组的近平滑念珠菌分离率明显高于免疫抑制组;对三唑类抗真菌药物的整体敏感率免疫抑制组低于非免疫抑制组,耐药菌主要为热带念珠菌;发生念珠菌血症时,两组患者血清降钙素原和C反应蛋白值均高于参考值范围;免疫抑制组患者血清(1,3)-β-D葡聚糖(BDG)阴性率明显高于非免疫抑制组。结论根据患者不同免疫状态,更好识别不同患者的病原菌分布特点,有助于临床医师选择更合理的抗真菌药物。然而,血清BDG检测不能早期识别所有念珠菌血症患者,特别是免疫抑制患者,需要结合降钙素原和C反应蛋白值综合判断。

Objective To explore the laboratory characteristics including Candida species distribution,antifungal susceptibility testing and serum biomarkers in patients with candidemia in terms of immune status of patients.Methods We collected and retrospectively analyzed the data of patients with candidemia who were hospitalized in the First Affiliated Hospital of Chongqing Medical University during the period from January 2016 to December 2018.Results A total of 103 patients were enrolled in this analysis,including 58 patients in immunocompromised(IC)group and 45 patients in immunocompetent(NIC)group.Indwelling catheter and total parenteral nutrition were more prevalent in NIC group than in IC group(P<0.05).Significant higher proportion of Candida parapsilosis(43.8%vs 18.6%,P=0.005)was observed in NIC group and significant higher proportion of Candida tropicalis(4.2%vs 32.2%,P<0.001)isolates in IC group.The fungal strains in IC group showed significant lower susceptiblity rate to triazoles compared to the strains in NIC group(81.4%vs 95.8%,P=0.023).Most of the triazole-resistant isolates were Candida tropicalis from IC group.Serum levels of procalcitonin and C-reactive protein were higher than upper normal limit in both groups of candidemia.Additionally,negative rate of(1,3)-β-D-glucan level was significantly higher in IC group than in NIC group(31.0%vs 13.3%,P=0.035).Conclusions Better understanding of the laboratory characteristics of candidemia in terms of immune status of patients could facilitate the management of candidemia patients to receive early and appropriate antifungal therapy.Moreover,serum(1,3)-β-D-glucan level is not suitable for early identification of candidemia,especially in immunocompromised patients.