真菌感染性败血症新生儿凝血纤溶系统变化及对预后的影响观察
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摘要
目的探讨新生儿真菌性败血症感染率以及患儿凝血纤溶系统相关指标的变化情况,为临床诊治实践提供参考借鉴依据。方法选取2012年12月-2017年6月医院收治的新生儿5 984例为研究对象进行回顾性分析,同时选取健康新生儿25名为研究对象,对真菌感染败血症患儿和健康儿童的凝血纤溶系统相关指标(AT-III)活性、D-二聚体(DD)水平和血小板(PLT)数量、血清炎症因子指标(肿瘤坏死因子-α(TNF-α)、白细胞介素-4(IL-4)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)和白细胞介素-12(IL-12))以及T细胞亚群指标进行观察和比较(CD_3~+CD_4~+、CD_3~+CD_8~+、CD_4~+CD_(45)~+、CD_8~+CD_(45)~+)。结果 5 984例新生儿中,真菌感染败血症患儿25例,真菌感染发生率为0.42%;真菌感染性败血症患儿的TNF-α、IL-4、IL-6、IL-8和IL-12等血清炎症因子水平均高于健康新生儿(P<0.05);真菌感染性败血症患儿的CD_3~+CD_4~+和CD_3~+CD_8~+均低于健康新生儿(P<0.05);真菌感染性败血症患儿的AT-III和PLT均低于健康新生儿(P<0.05),真菌感染性败血症患儿的DD高于健康新生儿(P<0.05);25例真菌感染患儿死亡14例,病死率56.00%。结论新生儿真菌感染性败血症患儿感染后的促炎和抗炎过程被显著激活,凝血纤溶功能呈现紊乱表现,患儿临床预后效果极差,临床上应给予主动预防和早期干预。
OBJECTIVE To investigate the infection rate of neonatal fungal septicemia and the changes of parameters related to the coagulation and fibrinolytic system,and to provide reference for clinical diagnosis and treatment practice.METHODS 5984 newborns admitted to the hospital from Dec.2012 to Jun.2017 were selected for retrospective analysis.At the same time,25 healthy neonates were selected as the research objects.The activity of coagulation and fibrinolysis system(AT-III),D-dimer(DD)and platelet(PLT)levels,serum inflammatory factors including tumor necrosis factor-α(TNF-α),interleukin-4(IL-4),interleukin-6(IL-6),interleukin-8(IL-8)and interleukin-12(IL-12)and T cell subsets(CD_3~+CD_4~+,CD_3~+CD_8~+,CD_4~+CD_(45)~+,CD_8~+CD_(45)~+)in newborns with fungal infections and healthy infants were observed and compared.RESULTS Among the 5984 newborns,25 were septic infants with fungal infection,and the incidence of fungal infection was 0.42%.The serum levels of TNF-α,IL-4,IL-6,IL-8 and IL-12 in infants with fungal sepsis were significantly higher than those in non-infected infants(P<0.05).The CD_3~+CD_4~+and CD_3~+CD_8~+in infants with fungal sepsis were lower than those in non-infected infants(P<0.05).The AT-III and PLT in infants with fungal sepsis were significantly lower than those in non-infected infants(P<0.05),whereas DD in infants with fungal sepsis was significantly higher than that in non-infected infants(P<0.05).14 cases died in the 25 cases of infants with fungal infection,the mortality rate was 56.00%.CONCLUSIONClinical attention should be paid to the incidence of neonatal fungal sepsis.The pro-inflammatory and anti-inflammatory processes in children are significantly activated after infection.The coagulation and fibrinolysis function is disordered.The clinical outcomes of children are extremely poor and should be given clinical active prevention and early intervention.
OBJECTIVE To investigate the infection rate of neonatal fungal septicemia and the changes of parameters related to the coagulation and fibrinolytic system,and to provide reference for clinical diagnosis and treatment practice.METHODS 5984 newborns admitted to the hospital from Dec.2012 to Jun.2017 were selected for retrospective analysis.At the same time,25 healthy neonates were selected as the research objects.The activity of coagulation and fibrinolysis system(AT-III),D-dimer(DD)and platelet(PLT)levels,serum inflammatory factors including tumor necrosis factor-α(TNF-α),interleukin-4(IL-4),interleukin-6(IL-6),interleukin-8(IL-8)and interleukin-12(IL-12)and T cell subsets(CD_3~+CD_4~+,CD_3~+CD_8~+,CD_4~+CD_(45)~+,CD_8~+CD_(45)~+)in newborns with fungal infections and healthy infants were observed and compared.RESULTS Among the 5984 newborns,25 were septic infants with fungal infection,and the incidence of fungal infection was 0.42%.The serum levels of TNF-α,IL-4,IL-6,IL-8 and IL-12 in infants with fungal sepsis were significantly higher than those in non-infected infants(P<0.05).The CD_3~+CD_4~+and CD_3~+CD_8~+in infants with fungal sepsis were lower than those in non-infected infants(P<0.05).The AT-III and PLT in infants with fungal sepsis were significantly lower than those in non-infected infants(P<0.05),whereas DD in infants with fungal sepsis was significantly higher than that in non-infected infants(P<0.05).14 cases died in the 25 cases of infants with fungal infection,the mortality rate was 56.00%.CONCLUSIONClinical attention should be paid to the incidence of neonatal fungal sepsis.The pro-inflammatory and anti-inflammatory processes in children are significantly activated after infection.The coagulation and fibrinolysis function is disordered.The clinical outcomes of children are extremely poor and should be given clinical active prevention and early intervention.
引文
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[11]Ghassabi F,Hashempour T,Moghadami M,et al.Bacterial etiology and antibiotic resistance pattern of septicemia in HIVand non-HIV patients admitted to tertiary care hospitals,Shiraz,South of Iran[J].Cell Mol Biol(Noisy-le-grand),2017,63(9):115-121.
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[14]Inoue T,Itani T,Inomata N,et al.Listeria monocytogenes septicemia and meningitis caused by listeria enteritis complicating ulcerative colitis[J].Intern Med,2017,56(19):2655-2659.
[15]Sun T,Yin WL,Fang BH,et al.Prediction of G gene epitopes of viral hemorrhagic septicemia virus and eukaryotic expression of major antigen determinant sequence[J].Cell Mol Biol,2017,63(7):84-88.
[16]Tong G,Wei X,Yin W,et al.Development of a liquid chip technique to simultaneously detect spring viremia of carp virus,infectious hematopoietic necrosis virus,and viral hemorrhagic septicemia of salmonids[J].J AOAC Int,2017,100(1):159-164.
[17]富琴琴,沈国松,蒋琦,等.极/超低出生体质量儿医院感染败血症的临床特征与病原学分析[J].中华医院感染学杂志,2016,26(21):4955-4957.
[18]Govindaraj G,Krishnamoorthy P,Nethrayini KR,et al.Epidemiological features and financial loss due to clinically diagnosed haemorrhagic septicemia in bovines in Karnataka,India[J].Prev Vet Med,2017,144:123-133.
[19]贾忠兰,毕福玲,张彩明.新生儿败血症病原菌分布及耐药性分析[J].中华医院感染学杂志,2017,27(1):197-200.
[2]Goonewardene KB,Popowich S,Gunawardana T,et al.Intrapulmonary delivery of CpG-ODN microdroplets provides protection against Escherichia coli septicemia in neonatal broiler chickens[J].Avian Dis,2017,61(4):503-511.
[3]Hwang JY,Jeong JM,Kwon MG,et al.Olive flounder CD276(B7-H3)a coinhibitory molecule for T cells:responses during viral hemorrhagic septicemia virus(VHSV)stimulation[J].Fish Shellfish Immunol,2018,73:228-233.
[4]Kim KI,Kim YC,Kwon WJ,et al.Evaluation of blue mussel Mytilus edulis as vector for viral hemorrhagic septicemia virus(VHSV)[J].Dis Aquat Organ,2017,126(3):239-246.
[5]Getchell RG,Cornwell ER,Bogdanowicz S,et al.Complete sequences of 4viral hemorrhagic septicemia virus IVb isolates and their virulence in northern pike fry[J].Dis Aquat Organ,2017,126(3):211-227.
[6]尚红,王毓三,申子瑜.全国临床检验操作规程[M].第4版.北京:人民卫生出版社,2015:412-413.
[7]孟庆兰,曾慧,李莉,等.新生儿重症监护病房真菌败血症医院感染暴发调查[J].中华医院感染学杂志,2017,27(8):1849-1851.
[8]Liu H,Zhao Z,Xue Y,et al.Fatal cases of Citrobacter freundii septicemia and encephalitis in sheep[J].J Vet Diagn Invest,2018,30(2):245-248.
[9]Muangthai K,Tankaew P,Varinrak T,et al.Intranasal immunization with a recombinant outer membrane protein Hbased haemorrhagic septicemia vaccine in dairy calves[J].JVet Med Sci,2018,80(1):68-76.
[10]Cho SY,Kwon YK,Nam M,et al.Integrated profiling of global metabolomic and transcriptomic responses to viral hemorrhagic septicemia virus infection in olive flounder[J].Fish Shellfish Immunol,2017,71:220-229.
[11]Ghassabi F,Hashempour T,Moghadami M,et al.Bacterial etiology and antibiotic resistance pattern of septicemia in HIVand non-HIV patients admitted to tertiary care hospitals,Shiraz,South of Iran[J].Cell Mol Biol(Noisy-le-grand),2017,63(9):115-121.
[12]Tiwari S,Pattanaik S,Beriha SS.Nonpigmented strain of Chromobacterium violaceum causing neonatal septicemia:a rare case report[J].Indian J Pathol Microbiol,2017,60(3):427-479.
[13]Singh M,Verma R,Pandit RS,et al.Host responses and bacterial colonization following inoculation of Pasteurella multocida P52strain into unvaccinated and aluminum hydroxide gel hemorrhagic septicemia vaccinated mice[J].Microb Pathog,2017,111:269-273.
[14]Inoue T,Itani T,Inomata N,et al.Listeria monocytogenes septicemia and meningitis caused by listeria enteritis complicating ulcerative colitis[J].Intern Med,2017,56(19):2655-2659.
[15]Sun T,Yin WL,Fang BH,et al.Prediction of G gene epitopes of viral hemorrhagic septicemia virus and eukaryotic expression of major antigen determinant sequence[J].Cell Mol Biol,2017,63(7):84-88.
[16]Tong G,Wei X,Yin W,et al.Development of a liquid chip technique to simultaneously detect spring viremia of carp virus,infectious hematopoietic necrosis virus,and viral hemorrhagic septicemia of salmonids[J].J AOAC Int,2017,100(1):159-164.
[17]富琴琴,沈国松,蒋琦,等.极/超低出生体质量儿医院感染败血症的临床特征与病原学分析[J].中华医院感染学杂志,2016,26(21):4955-4957.
[18]Govindaraj G,Krishnamoorthy P,Nethrayini KR,et al.Epidemiological features and financial loss due to clinically diagnosed haemorrhagic septicemia in bovines in Karnataka,India[J].Prev Vet Med,2017,144:123-133.
[19]贾忠兰,毕福玲,张彩明.新生儿败血症病原菌分布及耐药性分析[J].中华医院感染学杂志,2017,27(1):197-200.