高血糖可作为早产儿侵入性真菌感染的预测性指标

作     者：Manzoni P. Castagnola E. Mostert M. 李开 

作者机构：Neonatology Unit Hospital NICU Ospedale S. Anna Corso Spezia 60 10136 Turin Italy 

出 版 物：《世界核心医学期刊文摘（儿科学分册）》 (Dkgest of the World Latest Medical Information)

年 卷 期：2006年第2卷第A10期

页      面：11-11页

学科分类：1002[医学-临床医学] 100202[医学-儿科学] 10[医学] 

主　　题：侵入性真菌感染 高血糖 早产新生儿 微生物学检查 脓毒症 细菌感染 三级护理 血浆葡萄糖 用药天数 

摘      要：Aim: The incidence of invasive fungal infection in preterm newborns is rising steadily. Early recognition and treatment are imperative, but diagnosis is difficult as data from microbiological investigations are often poor, and clinical and laboratory signs do not help in differentiating bacterial from fungal infections. We evaluated whether glucose intolerance could represent a possible surrogate marker predictor of invasive fungal infection in preterm neonates. Methods: We performed a case- control study on neonates with birthweight less than 1250 g admitted to our tertiary- level unit during the years 1998- 2004 (n = 383), comparing those with invasive fungal infection (n = 45, group A) to matched controls with late- onset sepsis caused by bacterial agents (n = 46, group B). We investigated in both groups the occurrence of hyperglycaemia (serum glycaemia 215 mg/dl, i.e. 12 mmol/l) in the first month of life, and its temporal relationship with the episodes of sepsis. Results: Hyperglycaemia occurred significantly more often in group A (21/45, 46.6% ) than in group B neonates (11/46, 23.9% ) (OR 1.95, 95% CI 1.235- 4.432, p = 0.008). Moreover, in 19 of 21 (90.4% ) neonates with hyperglycaemia in group A, the carbohydrate intolerance episode typically occurred 72 h prior to the onset of invasive fungal infection; in contrast, no temporal relationship was found in neonates with bacterial sepsis (p = 0.002). Correction of hyperglycaemia was successfully achieved in all neonates of both groups, with no significant differences in the number of days of insulin treatment needed to normalize glycaemia (p = 0.15). Conclusions: Hyperglycaemia is significantly more frequent in neonates who subsequently develop fungal rather than bacterial late- onset sepsis, with a typical 3- d interval. We suggest that a preterm neonate whose birthweight is less than 1250 g in its first month of life should be carefully evaluated for systemic fungal infection whenever signs of carbohydrate