血清(1,3)-β-D葡聚糖检测在新生儿真菌性败血症中的应用价值

Value of application of serum(1,3)-β-D-glucan in neonates’fungal sepsis

目的探讨血清(1,3)-β-D葡聚糖检测在新生儿侵袭性真菌感染中应用价值。方法回顾性分析2015年1月至2017年12月本院新生儿病房住院治疗无菌体液真菌培养阳性的新产儿临床资料和实验室数据,共收集病例数30例为感染组;同时收集同期无感染患儿资料25例为对照组。比较血清(1,3)-β-D葡聚糖、WBC和PLT计数,血CRP和PCT水平的差异,通过制作ROC曲线评判各个指标单独或联合应用在新生儿侵袭性真菌感染诊断中的效能。结果感染组血清(1,3)-β-D葡聚糖、CRP水平显著高于对照组,PLT显著低于对照组;血清(1,3)-β-D葡聚糖ROC曲线下面积为0.79,在cut-off值为13.69 pg/ml时,诊断的敏感度和特异度分别为76.0%、71.4%;血清(1,3)-β-D葡聚糖联合CRP检测有最佳的诊断效能;感染组治疗后血清(1,3)-β-D葡聚糖较治疗前有显著下降。结论血清(1,3)-β-D葡聚糖在侵袭性真菌感染诊断和疗效判断中有较高的效能,联合CRP应用可以进一步提高诊断效能。

Objective To evaluate the diagnostic value of serum(1,3)-β-D-glucan in neonatal invasive fungus infection.Methods We retrospectively analyzed the clinical and laboratory data of the neonates with invasive fungus infection admitted to the NICU of our hospital from January,2015 to December,2017;thirty neonates were included as an infected group.Meanwhile,twenty-five neonates without infection were enrolled as a control group.The serum(1,3)-β-D-glucan,WBC and PLT count,and levels of CRP and PCT were compared between the two groups;and the ROC of serum(1,3)-β-D-glucan alone or in combine with CRP,PCT or PLT was drawn to evaluate the diagnostic efficacy.Results Compared with non-infected group,the serum levels of(1,3)-β-D-glucan and CRP were higher the PLT level was lower in the infected group than in the control group.The area under the ROC of serum(1,3)-β-D-glucan was 0.79;and with cut-off value of 13.69 pg/ml,its sensitivity and specificity were 76.0%and 71.4%,respectively.The combination of serum(1,3)-β-D-glucan with CRP had the best diagnostic value.The serum level of(1,3)-β-D-glucan was significantly lower after than before the treatment.Conclusions There is great value of serum(1,3)-β-D-glucan detection in the diagnose of neonatal invasive fungus infection and in the evaluation of anti-fungus treatment.The combination of serum(1,3)-β-D-glucan with CRP further increases the diagnostic value.