Application Of Plasma 1,3-β-D-glucan In The Early Diagnosis And Clinical Judgment Of Neonatal Fungal Septicemia

Objective To study the application of plasma l,3-β-D-glucan in the early diagnosis and treatment of fungal septicemia in neonatals.MethodsObjects: 82 hospitalized neonatals who were suspected neonatal fungal septicemia from September 2012-2014 December, including 44 males and 38 females were enrolled in this study. According to " Practical Neonatology(Fourth Edition)",they were divided into two groups:50 neonatals in group of fungal septicemia and 32 infants in group of non- fungal septicemia.Research methods:1) Data collection:to record gestational age, birth weight, delivery mode, gender, age, underlying diseases, clinical manifestations, invasive operation. 2) sample test:to take 2 ~ 5ml peripheral blood in blood culture(children bottle) from neonatals who were suspected as fungal septicemia.Then placed to BACTEC9120 automated blood culture system for 5 days. Using pyrogen anticoagulation with heparin tubes to preclude venous blood for 2ml, inspected within 2 hours to test plasma(1-3)-β-D- glucan content(G test). Detected the white blood cell(WBC), neutrophil cell percentage(N%), platelet(PLT) and high-sensitivity C-reactive protein(hs-CRP) simultaneous.Data analysis: We used SPSS 19.0 software to analyse the datas. Count data using percentages to statistical description. Variables between the two groups were compared by the chi-square test. We use mean ± standard deviation to describe continuous variables of measurement data that normally distributed by normality test, two groups were compared by T-test. Using Median to describe continuous variables of measurement data that not meet the normal distribution by normality test, two groups were compared by the Mann-Whitney U-test. To determine the best cutoff value of the three ways to diagnose IFI according to Youden’s index by drawing Operating Characteristic curve(ROC) of 1,3-β-D-glucan, PLT, and hs-CRP. Calculated the specificity,sensitivity,positive predictive value and negative predictive value by the cut-off point.Results1. The WBC counts and N% counts are not significantly differences between the group of fungal septicemia and the non- fungal septicemia in neonatals.(P>0.05).2. The levels of plasma(1-3)-β-D- glucan and hs-CRP in the group of fungal septicemia are higher than those in the non-fungal septicemia group. There are significantly differences between the two groups. The levels of PLT in the group of fungal septicemia are lower than those in the non fungal septicemia group.(P<0.01).3. The sensitivity and speciality of(1-3)-β-D- glucan level are higher than those of hs-CRP、PLT.4. Positive and negative predictive values of(1-3)-β-D- glucan are 25.00% and 94.12%.5. The content of plasma 1,3-β-D-glucan was significantly decreased in the group of fungal septicemia after ntifungal treatment for 3 days and 7 days(Z1=-5.990,Z2=--6.067,P1=0.000,P2=0.000).Conclusion1. WBC and N% are not good marks in distinguishing with and without fungal septicemia between neonates.2.PLT and hs-CRP have diagnostic value in neonatals with fungal septicemia,but their sensitivities are lower than that of plasma(1-3)-β-D- glucan.3. Plasma(1-3)-β-D- glucan is possiblly a early sensitive maker of fungal septicemia in neonates.4. The dynamic monitoring of plasma(1-3)-β-D-glucan can be used to assess the therapeutic effect of sepsis fungal in neonatals.