真菌血流感染患者病原菌分布及血生化指标水平

Distribution of pathogens isolated from patients with fungal bloodstream infection and blood biochemical indexes

目的探讨真菌血流感染患者病原菌分布特点及血生化指标水平变化与意义。方法选取2016年1月-2019年6月郑州大学附属郑州中心医院检验科经血培养确诊为真菌血流感染的患者100例,根据感染类型将其分为血流真菌感染组(50例)、局部真菌感染组(50例),另选50名同期健康人群为对照组。对血流真菌感染组的病原菌进行分离、培养及检测并观察其真菌分布特点;比较三组血浆(1,3)-β-D葡聚糖、C-反应蛋白(CRP)、降钙素原(PCT)水平;对比血流真菌感染组患者不同病原菌感染的血浆(1,3)-β-D葡聚糖、CRP、PCT水平。结果血流真菌感染组共分离出菌株50株,其中白假丝酵母17株,非白假丝酵母33株。血流真菌感染组(1,3)-β-D葡聚糖低于局部真菌感染组和对照组(P<0.05),CRP、PCT水平均高于局部真菌感染组和对照组(P<0.05);局部真菌感染组血浆(1,3)-β-D葡聚糖水平、CRP、PCT水平均高于对照组(P<0.05)。白假丝酵母组血浆(1,3)-β-D葡聚糖、CRP、PCT水平均低于非白假丝酵母组(P<0.05)。结论真菌血流感染患者病原菌以热带假丝酵母为主,血浆(1,3)-β-D葡聚糖、CRP、PCT水平的检测有助于快速诊断真菌血流感染。

OBJECTIVE To explore the distribution of pathogens isolated from the patients with fungal bloodstream infection,change of blood biochemical indexes and their significance.METHODS From Jan 2016 to Jun 2019,totally 100 patients who were diagnosed with fungal bloodstream infection by blood culture in clinical laboratory of Zhengzhou Central Hospital Affiliated to Zhengzhou University were enrolled in the study and divided into the bloodstream fungal infection group with 50 cases and the local fungal infection group with 50 cases,meanwhile,50 healthy people were set as the control group.The pathogens were isolated from the patients in the bloodstream fungal infection group,and the distribution of the fungi was observed.The levels of plasma(1,3)-β-D glucan,C-reactive protein(CRP)and procalcitonin(PCT)were compared among the 3 groups;the levels of plasma(1,3)-β-D glucan,CRP and PCT were compared among the bloodstream fungal infection patients.RESULTS A total of 50 strains of pathogens were isolated from the patients in the bloodstream fungal infection group,17 of which were Candida albicans,and 33 were non-C.albicans strains.The plasma(1,3)-β-D glucan level of the bloodstream fungal infection group was significantly lower than that of the local fungal infection group and the control group(P<0.05),the levels of CRP and PCT of the bloodstream fungal infection group were significantly higher than those of the local fungal infection group and the control group(P<0.05);the levels of plasma(1,3)-β-D glucan,CRP and PCT of the local fungal infection group were significantly higher than those of the control group(P<0.05).The levels of plasma(1,3)-β-D glucan,CRP and PCT of the C.albicans group were lower than those of the non-C.albicans group(P<0.05).CONCLUSION Candida tropicalis is dominant among the pathogens isolated from the patients with fungal bloodstream infection.The detection of plasma(1,3)-β-D glucan,CRP and PCT may facilitate the rapid diagnosis of fungal bloodstream infection.