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目的探讨新生儿痰真菌生长的临床意义及相关因素。方法回顾性分析149例诊断为新生儿肺炎且痰培养结果阳性住院新生儿的临床资料,根据痰培养结果将患儿分为真菌组、混合组和细菌组,运用χ~2检验及方差分析等统计学方法,比较三组的临床资料。结果 (1)真菌组40例、混合组30例和细菌组79例,痰真菌生长占47.0%(70/149)。(2)三组间白细胞数分别为(10.3±3.5)×10~9/L、(11.7±5.2)×10~9/L 和(14.4±10.5)×10~9/L,F=3.78,P=0.03;中性粒细胞数分别为(5.1±3.3)×10~9/L、(7.4±4.7)×10~9/L、(9.0±7.4)×10~9/L,F=5.50,P=0.01;下列因素所占比例,三组分别为:早产儿32.5%(13/40)、20%(6/30)和12.7%(10/79),χ~2=6.68,P=0.04;母产前使用糖皮质激素10.0%(4/40)、6.7%(2/30)和0%(0/79),P=0.01;使用三联抗生素治疗10.0%(4/40)、16.7%(5/30)和2.5%(2/79),P=0.02;碳青霉烯类药物治疗32.55(13/40)、63.3%(19/30)和17.7%(14/79),χ~2=21.26,P=0.00。上述6个因素三组间差异均有显著统计学意义。(3)以痰真菌生长作为因变量进行 Logistic 回归分析,共2个变量进入最佳回归方程:碳青霉烯类药物(克倍宁或泰能)治疗(X_1)、早产儿(X_2),建立影响痰真菌生长的主效应模型 Logistic(SCF)=β_0(0.12)+1.63X_1+1.20X_2(χ~2=43.04,P<0.05)。(4)仅一次痰真菌生长,抗真菌治疗与否未愈率分别为10.0%(2/22)和0%(0/43),P=0.111;继续住院时间分别为(225.8±7.7)d 和(434.1±4.7)d,t=1.095,P=0.278,均无统计学意义。结论 (1)在新生儿肺炎中,痰真菌生长比较普遍,以白色念珠菌为主。(2)早产儿、碳青霉烯类抗生素治疗可作为痰真菌生长的独立危险因素。(3)仅一次痰真菌生长只提示需作进一步真菌检查,不能凭此确诊肺部真菌感染或决定是否抗真菌治疗。
Objective To investigate the clinical significance of neonatal sputum fungus growth and related factors. Methods A retrospective analysis of 149 cases diagnosed as neonatal pneumonia and sputum culture positive hospitalized newborns clinical data, according to the results of sputum culture were divided into fungal group, mixed group and bacteria group, using χ ~ 2 test and analysis of variance Statistical methods, the clinical data of three groups were compared. Results (1) Forty fungal groups, 30 mixed groups and 79 bacterial groups, the sputum fungi accounted for 47.0% (70/149). (2) The number of leukocytes in the three groups were (10.3 ± 3.5) × 10 ~ 9 / L, (11.7 ± 5.2) × 10 ~ 9 / L and (14.4 ± 10.5) × 10 ~ 9 / L, P = 0.03; neutrophil count was (5.1 ± 3.3) × 10 ~ 9 / L, (7.4 ± 4.7) × 10 ~ 9 / L and (9.0 ± 7.4) × 10 ~ , P = 0.01. The proportions of the following three groups were 32.5% (13/40), 20% (6/30) and 12.7% (10/79), respectively, 0.04; pre-birth glucocorticoid 10.0% (4/40), 6.7% (2/30) and 0% (0/79), P = 0.01; triple antibiotic treatment with 10.0% (4/40), 16.7 (13/40), 63.3% (19/30) and 17.7% (14/79), respectively; χ (5/30) and 2.5% (2/79) ~ 2 = 21.26, P = 0.00. The above six factors between the three groups were statistically significant differences. (3) According to Logistic regression analysis, sputum and fungal growth were used as dependent variables. Two variables entered the best regression equation: carbapenem treatment (X 1), premature infants (X 2) Logistic (SCF) = β_0 (0.12) + 1.63X_1 + 1.20X_2 (χ ~ 2 = 43.04, P <0.05) was established to establish the main effect model that affected the growth of sputum fungi. (4) Only one sputum fungus growth, antifungal therapy or not cured rates were 10.0% (2/22) and 0% (0/43), P = 0.111; continued hospital stay were (225.8 ± 7.7) d And (434.1 ± 4.7) days, respectively, t = 1.095, P = 0.278, no statistical significance. Conclusions (1) In neonatal pneumonia, the growth of sputum fungi is relatively common, mainly Candida albicans. (2) The treatment of preterm infants and carbapenem antibiotics can be used as independent risk factors for the growth of sputum fungi. (3) Only one sputum fungus growth only prompted the need for further fungal examination, can not be diagnosed with pulmonary fungal infection or decide whether anti-fungal treatment.