早产儿假丝酵母菌败血症时血小板的变化

目的探讨早产儿假丝酵母菌败血症时血小板的变化。方法回顾性分析2008年2月至2010年2月在本院住院的假丝酵母菌败血症早产儿的临床表现,比较患儿入院时、发生真菌败血症时、抗真菌治疗2周后3个时间点的血常规特别是血小板的变化和C反应蛋白(CRP)变化。结果白假丝酵母菌败血症13例,近平滑假丝酵母菌败血症11例。24例患儿发生假丝酵母菌败血症时与入院时比较,WBC(×109/L)差异无统计学意义[(8.5±4.3)比(8.6±2.9),P>0.05]。PLT(×109/L)降低,CRP(mg/L)、血小板平均体积(MPV,fl)和血小板分布宽度(PDW,%)升高[PLT:(99.8±49.1)比(197.0±62.8),CRP:(29.3±34.5)比(2.7±3.4),MPV:(12.3±0.9)比(11.1±1.1),PDW:(17.6±3.2)比(13.6±2.7),P均<0.05]。近平滑假丝酵母菌组发生败血症时PLT明显低于白假丝酵母菌组[(73.0±40.9)比(122.5±44.8),P<0.05],其余血常规指标在3个不同时间点两组相比差异均无统计学意义(P>0.05)。结论早产儿真菌败血症时血常规变化最明显的指标是PLT降低,与白假丝酵母菌败血症相比,近平滑假丝酵母菌败血症PLT降低更明显,分析PLT可辅助指导真菌败血症的诊断和早期经验治疗。

Significance of platelet changes during candida parapsilosis sepsis in preterm infants

Objective To study the characteristic changes of platelets during candida sepsis in premature infants.Methods Clinical manifestations of 24 preterm infants who developed candida sepsis during hospitalization were analyzed retrospectively.Complete blood counts(CBC) and CRP were measured at 3 different time-points:at the time of admission,at the occurrence of fungal sepsis and after two weeks of anti-fungal treatment and the results were compared using one way ANOVA analysis.Results In all 24 premature babies who developed candida sepsis,13 patients were diagnosed with candida albicans septicemia,and 11 with candida parapsilosis sepsis.At the time of candida sepsis,the WBC amount was not significantly changed comparing with the level at the time of hospital admission [WBC:(8.5 ±4.3) × 10 9 /L vs.(8.6 ± 2.9) × 10 9 /L,P > 0.05].In contrast,several parameters were significantly increased(P < 0.05) during fungal sepsis [PLT:(99.8 ± 49.1) × 10 9 /L vs.(197.0 ±62.8) ×10 9 /L],CRP:[(29.3 ± 34.5) mg /L vs.(2.7 ± 3.4) mg /L];MPV:[(12.3 ± 0.9) fl vs.(11.1 ± 1.1) fl],and PDW:[(17.6 ± 3.2) % vs.(13.6 ± 2.7) %] P < 0.05].Furthermore,platelet level in the candida parapsilosis sepsis group was lower than the level in the candida albicans group [(73.0 ± 40.9) × 10 9 /L vs.(122.5 ± 44.8) × 10 9 /L,P < 0.05].The remaining parameters in CBC analysis at the three different time points among the two groups were not statistically significant(P > 0.05).Conclusions The most prominent CBC indicator of fungal septicemia in premature infants is thrombocytopenia.Comparing with the platelet level during candida albicans sepsis,thrombocytopenia is more severe during candida parapsilosis sepsis.Therefore,close monitoring platelet level may help early diagnosis and treatment of candida sepsis.