早产儿白假丝酵母菌败血症13例临床分析

花少栋,吴志新,黄捷婷,封志纯

中国当代儿科杂志 ›› 2012, Vol. 14 ›› Issue (10) : 728-732.

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中国当代儿科杂志 ›› 2012, Vol. 14 ›› Issue (10) : 728-732.
论著·临床研究

早产儿白假丝酵母菌败血症13例临床分析

  • 花少栋,吴志新,黄捷婷,封志纯
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Clinical features of Candida albicans sepsis in preterm infants: an analysis of 13 cases

  • HUA Shao-Dong, WU Zhi-Xin, HUANG Jie-Ting, FENG Zhi-Chun
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摘要

目的:探讨早产儿白假丝酵母菌败血症的临床特点。方法:回顾性分析13例早产儿白假丝酵母菌败血症患儿的临床资料。患儿胎龄28~36周,体重1400~2815 g。结果:患儿发生白假丝酵母菌感染的时间为生后19±11 d。临床表现主要为:呼吸暂停、皮肤灌注差、反应差、反复血氧下降、皮肤灰暗、皮肤黄染、安静状态心率增快、痰多、撤机困难。在白假丝酵母菌感染时患儿血小板明显下降,C反应蛋白、血小板分布宽度升高。谷丙转氨酶、肌酸激酶同工酶、总胆红素、肌酸激酶、乳酸脱氢酶在白假丝酵母菌感染时升高,抗真菌治疗两周后肌酸激酶、乳酸脱氢酶下降明显。仅3例对氟康唑耐药,换用伏立康唑治疗有效,10例治愈,放弃治疗2例,死亡1例。结论:早产儿白假丝酵母菌败血症临床表现非特异性,生后2~3周的早产儿并发的感染,应考虑白假丝酵母菌感染的可能。白假丝酵母菌感染时,患儿血小板下降,C反应蛋白、血小板分布宽度升高、谷丙转氨酶、肌酸激酶同工酶、总胆红素、肌酸激酶、乳酸脱氢酶升高。

Abstract

OBJECTIVE: To investigate the clinical features of Candida albicans sepsis in preterm infants. METHODS: Retrospective analysis was performed on the clinical data of 13 preterm infants with Candida albicans sepsis, who were born at 28 to 36 weeks of gestational age and who weighed between 1400 and 2815 g. RESULTS: The infants were infected with Candida albicans at the age of 19±11 d, with the main clinical manifestations being apnea, poor response, poor skin perfusion, blood oxygen concentration decrease, dark skin, yellowish skin, heart rate increase in the rest state, copious phlegm and difficulty in weaning from the ventilator. The infants showed significantly decreased platelet and increased C-reactive protein (CRP), platelet distribution width (PDW), alanine transaminase (ALT), creatine kinase isoenzyme-MB (CK-MB), total bilirubin (TBIL), creatine kinase (CK), and lactate dehydrogenase (LDH). CK and LDH were significantly decreased after 2 weeks of antifungal therapy. Only 3 cases developed drug resistance to fluconazole and these showed response when treated with voriconazole instead. Of the 13 cases, 10 were cured, 2 abandoned therapy and 1 died. CONCLUSIONS: The clinical manifestations of Candida albicans sepsis are nonspecific in preterm infants. Infectious diseases are probably caused by Candida albicans in preterm infants 2-3 weeks after birth. Preterm infants show decreased platelet and increased CRP, PDW, ALT, CK-MB, TBIL, CK, and LDH when infected with Candida albicans.

关键词

败血症 / 白假丝酵母菌 / 临床特点 / 早产儿

Key words

Sepsis / Candida albicans / Clinical feature / Preterm infant

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导出引用
花少栋,吴志新,黄捷婷,封志纯. 早产儿白假丝酵母菌败血症13例临床分析[J]. 中国当代儿科杂志. 2012, 14(10): 728-732
HUA Shao-Dong, WU Zhi-Xin, HUANG Jie-Ting, FENG Zhi-Chun. Clinical features of Candida albicans sepsis in preterm infants: an analysis of 13 cases[J]. Chinese Journal of Contemporary Pediatrics. 2012, 14(10): 728-732
中图分类号: R722.6   

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