新生儿侵袭性真菌感染病原菌及外周血TLR4、CXCL13、PCT和CRP表达

Pathogens isolated from neonates with invasive fungal infection and expressions of peripheral blood TLR4,CXCL13,PCT and CRP

目的分析新生儿侵袭性真菌感染病原菌和临床特点及外周血Toll样受体4(TLR4)mRNA、趋化因子CXC配体13(CXCL13)mRNA、降钙素原(PCT)、C-反应蛋白(CRP)表达情况。方法选取2021年1月-2023年9月山东第一医科大学附属人民医院收治的68例侵袭性真菌感染新生儿为病例组,另选取90例同期收治的无感染新生儿为对照组。分析侵袭性真菌感染新生儿真菌分布情况,比较两组临床特点及外周血TLR4 mRNA、CXCL13 mRNA、PCT、CRP水平,并分析对外周血TLR4 mRNA、CXCL13 mRNA、PCT、CRP单一及联合检测对新生儿侵袭性真菌感染的预测价值。结果68例侵袭性真菌感染新生儿检出真菌75株,以白假丝酵母(44株)检出最多,占比为58.67%。病例组胎龄<37周、出生体质量<2400 g、机械通气时间≥7 d、住院时间≥8 d比例及外周血TLR4 mRNA、CXCL13 mRNA、PCT、CRP水平高于对照组(P<0.05)。外周血TLR4 mRNA、CXCL13 mRNA、PCT、CRP联合检测预测新生儿侵袭性真菌感染的曲线下面积(AUC)值为0.945,高于四指标单一检测(P<0.05)。结论侵袭性真菌感染新生儿检出真菌以白假丝酵母占比最多,其发生与胎龄<37周、出生体质量<2400 g、机械通气时间≥7 d、住院时间≥8 d有关,且患儿外周血TLR4 mRNA、CXCL13 mRNA、PCT、CRP水平呈高表达,四指标联合检测的预测价值更高。

OBJECTIVE To analyze the distribution of pathogens isolated from the neonates with invasive fungal infection,clinical characteristics and expressions of peripheral blood Toll-like receptor 4(TLR4)mRNA,chemokine CXC ligand 13(CXCL13)mRNA,procalcitonin(PCT)and C-reactive protein(CRP).METHODS A total of 68 neonates with invasive fungal infection who were treated in Shandong First Medical University Affiliated People′s Hospital from Jan.2021 to Sep.2023 were assigned as the case group,meanwhile,90 neonates who did not have the infection were chosen as the control group.The distribution of fungi isolated from the neonates with invasive fungal infection was observed.The clinical characteristics and levels of peripheral blood TLR4 mRNA,CXCL13 mRNA,PCT and CRP were compared between the two groups.The values of the single and joint detection of the peripheral blood TLR4 mRNA,CXCL13 mRNA,PCT and CRP in prediction of the invasive fungal infection were analyzed.RESULTS Totally 75 strains of fungi were isolated from the 68 neonates with invasive fungal infection,58.67%(44)of which were Candida albicans.The proportions of neonates with gestational age less than 37 weeks,birth weight less than 2400g,mechanical ventilation duration no less than 7 days and length of hospital stay no less than 8 days as well as the levels of peripheral blood TLR4 mRNA,CXCL13 mRNA,PCT and CRP were higher in the case group than in the control group(P<0.05).The area under the curve(AUC)of the joint detection of peripheral blood TLR4 mRNA,CXCL13 mRNA,PCT and CRP was 0.945 in prediction of the invasive fungal infection in the neonates,higher than that of the single detection(P<0.05).CONCLUSIONS The C.albicans is the predominant species of fungi isolated from the neonates with invasive fungal infection,which is associated with the gestational age less than 37 weeks,birth weight less than 2400g,mechanical ventilation duration no less than 7 days and length of hospital stay no less than 8 days.The neonates with the invasive fungal infection show high expressions of peripheral blood TLR4 mRNA,CXCL13 mRNA,PCT and CRP.The joint detection of the four indexes has high predictive value.