Value of dynamic monitoring of plasma 1, 3-β-D-glucan in evaluating efficiency of drugs for treatment of premature infants with fungal septicemia
-
摘要: 目的 探讨动态监测1, 3-β-D-葡聚糖(BDG)评价早产儿真菌性败血症药物疗效的价值。 方法 动态监测湖南省儿童医院新生儿重症监护病房(NICU)2018年1月—2019年12月收治的30例真菌性败血症早产儿的血浆BDG水平。 结果 抗真菌治疗后,治疗有效患儿28例,其血浆BDG浓度显著降低,其中8例患儿血浆BDG下降至正常水平; 2例死亡患儿的血浆BDG呈进行性上升,并处于高水平状态。BDG未降至正常水平患儿的抗菌药物治疗时间长于BDG降至正常水平患儿,差异有统计学意义(P<0.05)。 结论 动态监测血浆BDG水平可评价所选抗真菌药物的有效性,且在评价真菌性败血症患儿预后方面也有一定的价值。Abstract: Objective To investigate the value of dynamic monitoring of 1, 3-β-D-glucan(BDG)in evaluating the efficiency of drugs for treatment of premature infants with fungal septicemia. Methods Plasma levels of BDG of 30 premature infants with fungal septicemia in Neonatal Intensive Care Unit(NICU)of Hunan Provincial Children's Hospital from January 2018 to December 2019 were dynamically monitored. Results After antifungal treatment, plasma BDG concentration in 28 cases with effective therapeutic result decreased significantly, among which 8 cases decreased to normal level; 2 dead cases showed progressive increase in plasma BDG, and were in a high level. The duration of antibiotic treatment in children with BDG not decreasing to normal level was significantly longer than that in children with BDG decreasing to normal level(P<0.05). Conclusion Dynamic monitoring of plasma BDG level can evaluate the efficacy of selected antifungal drugs, and also has a certain value in evaluating the prognosis of children with fungal septicemia.
-
Keywords:
- 1, 3-β-D-glucan /
- fungal septicemia /
- antifungal drugs /
- Neonatal Intensive Care Unit
-
-
ALIAGA S, CLARK R H, LAUGHON M, et al. Changes in the incidence of candidiasis in neonatal intensive care units[J]. Pediatrics, 2014, 133(2): 236-242.
郑莉莉, 夏红萍, 谢利娟, 等. 早产儿真菌性败血症临床特点及血浆1, 3-β-D葡聚糖检测意义[J]. 中国新生儿科杂志, 2011, 26(5): 296-299. 陶青松, 张步薇. 血浆(1-3)-β-D葡聚糖检测和真菌培养联合诊断对侵袭性真菌病的诊断价值[J]. 医学检验与临床, 2014, 25(6): 89-91. 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019: 532-533. 李世荣, 王红, 文艳. 血浆(1-3)-β-D-葡聚糖与抗深部白色念珠菌感染药物疗效关系的实验研究[J]. 临床和实验医学杂志, 2007, 6(6): 20-22. SENN L, ROBINSON J O, SCHMIDT S, et al. 1, 3-Beta-D-glucan antigenemia for early diagnosis of invasive fungal infections in neutropenic patients with acute leukemia[J]. Clin Infect Dis, 2008, 46(6): 878-885.
中华医学会重症医学分会. 重症患者侵袭性真菌感染诊断与治疗指南(2007)[J]. 中华内科杂志, 2007, 46(11): 960-966. FRIDKIN S K, KAUFMAN D, EDWARDS J R, et al. Changing incidence of Candida bloodstream infections among NICU patients in the United States: 1995-2004[J]. Pediatrics, 2006, 117(5): 1680-1687.
XIA H P, WU H, XIA S W, et al. Invasive Candidiasis in preterm neonates in China: a retrospective study from 11 NICUS during 2009-2011[J]. Pediatr Infect Dis J, 2014, 33(1): 106-109.
BARTON M, O'BRIEN K, ROBINSON J L, et al. Invasive candidiasis in low birth weight preterm infants: risk factors, clinical course and outcome in a prospective multicenter study of cases and their matched controls[J]. BMC Infect Dis, 2014, 14: 327-335.
KELLY M S, BENJAMIN D K JR, SMITH P B. The epidemiology and diagnosis of invasive candidiasis among premature infants[J]. Clin Perinatol, 2015, 42(1): 105-117.
BENJAMIN D K, STOLL B J, GNTZ M G, et al. Neonatal candidiasis: epidemology, risk factors, and clinical judgment[J]. Pediatrics, 2010, 126(4): e865-e869.
BENJAMIN D K. Neonatal candidiasis among extremely low birth weight infants: risk factors, mortality rates, and neurodevelopmental outcomes at 18 to 22 months[J]. Pediatrics, 2006, 117(1): 84-92.
PAPPAS P G, KAUFFMAN C A, ANDES D R, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the infectious diseases society of America[J]. Clin Infect Dis, 2016, 62(4): e1-e50.
HEALY C M, BAKER C J. Fluconazole prophylaxis in the neomatal intensive care unit[J]. Pediatr Infect Dis J, 2009, 28(1): 49-57.
CLEMINSON J, AUSTIN N, MCGUIRE W. Prophylactic systemic antifungal agents to prevent mortality and morbidity in very low birth weight infants[J]. Cochrane Database Syst Rev, 2015(10): CD003850.
中华医学会儿科学分会新生儿学组, 中国医师协会新生儿科医师分会感染专业委员会. 新生儿败血症诊断及治疗专家共识(2019年版)[J]. 中华儿科杂志, 2019, 57(4): 252-257. 余时娟, 李禄全. 新生儿真菌性败血症23例临床分析[J]. 临床儿科杂志, 2014, 32(9): 816-820. YU Y F, DU L Z, YUAN T M, et al. Risk factors and clinical analysis for invasive fungal infection in neonatal intensive care unit patients[J]. Am J Perinatol, 2013, 30(7): 589-594.
ASCHER S B, SMITH P B, WATT K, et al. Antifungal therapy and outcomes in infants with invasive Candida infections[J]. Pediatr Infect Dis J, 2012, 31(5): 439-443.
温冬华, 刘钰华, 谭坚, 等. 动态监测血浆(1, 3)-β-D-葡聚糖含量对评价侵袭性真菌感染患者药物疗效的价值[J]. 中国医药导报, 2017, 14(35): 110-113 , 117.
计量
- 文章访问数: 404
- HTML全文浏览量: 70
- PDF下载量: 10