G試驗對侵襲性真菌感染新生兒早期篩查價值分析

何景東 陳秀蓮 龐海明

【摘要】 目的：探討G試驗對侵襲性真菌感染（IPFI）新生兒早期篩查價值。方法：選取2016年1月-2019年6月本院收治的疑似IPFI新生兒260例作為真菌感染組，選取同期本院117例細菌感染新生兒作為細菌感染組，另選取本院同期健康新生兒54例作為對照組。三組均進行G試驗，比較三組血清1，3-β-D葡聚糖水平。以真菌培養結果為診斷金標準，比較IPFI與非IPFI患兒的血清1，3-β-D葡聚糖水平，分析G試驗在IPFI新生兒早期篩查中的價值。結果：真菌感染組血清1，3-β-D葡聚糖水平均高于細菌感染組與對照組（P<0.05）。真菌感染組中，IPFI患兒214例，非IPFI患兒46例。IPFI患兒的血清1，3-β-D葡聚糖水平高于非IPFI患兒（P<0.05）。214例IPFI患兒致病菌均為念珠菌屬，其中白色假絲酵母菌與近平滑假絲酵母菌占比較高。G試驗對IPFI診斷的敏感度為88.32%、準確度為88.08%、特異度為86.96%。結論：G試驗在IPFI新生兒早期篩查中具有較高診斷價值，可作為臨床對IPFI的早期預警指標，值得臨床推廣。

【關鍵詞】 G試驗 侵襲性真菌感染 早期篩查

[Abstract] Objective： To explore the value of G test in early screening of invasive pulmonary fungal infection （IPFI） in neonates. Method： A total of 260 suspected IPFI neonates admitted to our hospital from January 2016 to June 2019 were selected as the fungal infection group， 117 bacterial infection neonates in our hospital during the same period were selected as the bacterial infection group， and 54 healthy neonates in our hospital during the same period were selected as the control group. Serum 1，3-β-D glucan levels were compared among the three groups by G test. The serum 1，3-β-D glucan levels were compared between IPFI and non-IPFI neonates with fungal culture results as the gold standard for diagnosis， and the value of G test in early screening of IPFI neonates was analyzed. Result： The serum 1，3-β-D glucan level of the fungal infection group was higher than those of the bacterial infection group and the control group （P<0.05）. In the fungal infection group， 214 neonates with IPFI and 46 neonates with non-IPFI. The serum 1，3-β-D glucan level of IPFI neonates was higher than that of non-IPFI neonates （P<0.05）. The pathogenic bacteria of 214 IPFI neonates were all Candida， among which Candida albicans and Candida albicans accounted for a high proportion. The sensitivity， accuracy and specificity of G test to IPFI diagnosis were 88.32%， 88.08% and 86.96%. Conclusion： G test has high diagnostic value in early screening of IPFI neonates， it can be used as an early warning indicator of IPFI in clinical practice and is worthy of clinical promotion.

[Key words] G test Invasive pulmonary fungal infection Early screening

First-authors address： Clinical Laboratory of Maoming Maternal and Child Health Hospital， Maoming 525000， China

doi：10.3969/j.issn.1674-4985.2020.23.030

侵襲性真菌感染（invasive pulmonary fungal infection，IPFI）指的是一種侵襲人體器官、組織甚至全身的真菌感染，深部組織感染及真菌血癥，肺炎、黏膜及皮下組織感染、中樞神經系統感染、敗血癥、泌尿系統感染是其常見表現形式，嚴重者可能危及生命安全[1]。近年來，新生兒IPFI發生率逐年升高，病情進展快，且無明顯臨床特征，與細菌感染及其他常見新生兒疾病表現難以鑒別，常表現為低血壓、腹脹、喂養不耐受、低體溫、白細胞增多、血小板減少、呼吸困難等癥狀，嚴重者會導致骨、眼、腦部受到影響，因此給予早期診斷、治療是臨床研究重點[2-3]。真菌的實驗室檢查包括血清學檢查、涂片及真菌培養，血培養具有一定的診斷價值，DNA陽性率不高，耗時長，鑒定過程較為復雜，且血培養陰性也無法準確排除真菌感染[4]。有研究提出，血清1，3-β-D葡聚糖檢測（即G試驗）在真菌中具有一定的檢出價值，但在IPFI新生兒中應用較少[5]。本研究以真菌培養為IPFI新生兒診斷金標準，采用G試驗對疑似IPFI新生兒進行診斷，分析其在IPFI早期篩查中的診斷價值，現報道如下。