普外科婴幼儿侵袭性真菌感染的高危因素分析与评分系统建立

摘要/Abstract

摘要： 目的探讨普外科儿童侵袭性真菌感染的危险因素，建立风险评分系统。方法对2010年1月-2018年12月某儿童医院普外科诊断为IFI的82例住院患儿与同期、同病区82例基础疾病相似的非IFI住院患儿进行危险因素调查，对可能的危险因素进行单因素分析及非条件多因素logistic回归分析，筛选出IFI的危险因素。根据回归分析结果建立评分系统，将回归系数整数化赋值，建立评分公式，计算Z值，并绘制ROC曲线评价该评分系统的效能，根据cut-off值确定Z_临界值。通过该评分系统对2019年1月-12月227例入住同病区与上述评分系统组基础疾病相似患儿进行验证，并与根据诊断标准确诊或临床诊断的阳性率进行比较验证。结果单因素分析显示观察组住院天数长于对照组，腹腔引流管、肠外营养、中心静脉导管、机械通气>3 d、广谱抗菌药物>2周、两种以上抗菌药物联用、低蛋白血症、糖皮质激素>7 d等指标的所占比例均高于对照组，且具有统计学意义（P<0.05）。其他指标患儿年龄、性别、留置胃管和/或尿管、行胃肠道手术等指标与对照组比较，差异无统计学意义（P>0.05）。多因素logistic回归分析显示住院天数、两种以上抗菌药物联用，糖皮质激素应用>7 d为普外科婴幼儿IFI的独立危险因素。根据回归系数分别赋值2、26、15并建立评分系统，ROC曲线的AUC=0.880（95%CI：0.825~0.935，P<0.001），cut-off值为0.700，即在Z_临界值为63.5时，敏感度为0.778，特异性为0.922。验证组应用评分系统预测的阳性率与根据诊断标准确诊或临床诊断的阳性率相比，无统计学差异（P=0.074），Kappa=0.769，表明两种方法一致性好。应用评分系统的灵敏度为0.750，特异度为0.981，与cut-off值下的灵敏度与特异度基本一致。结论该评分系统效能良好，其正确性得到验证，对于临床早期识别普外科IFI高危患儿具有较好的应用价值。

关键词: 侵袭性真菌感染, 危险因素, 婴幼儿, 普外科, 评分系统

Abstract: Objective To investigate the risk factors of invasive fungal infection in pediatric patients of general surgical department and to establish a risk scoring system. Methods Risk factors of 82 hospitalized children diagnosed with IFI in the general surgery department of a children's hospital from January 2010 to December 2018 and 82 non IFI hospitalized children with similar basic diseases in the same ward were investigated. Possible risk factors were analyzed by univariate logistic regression analysis and non-conditional multivariate logistic regression analysis to select the risk factors of IFI. According to the results of regression analysis, a scoring system was established, the regression coefficient was integer assigned, the scoring formula was established, the z-value was calculated, and the ROC curve was drawn to evaluate the effectiveness of the scoring system, and the z-critical value was determined according to the cut-off value. The scoring system was used to verify 227 children admitted to the same ward from January to December 2019 with similar underlying diseases in the scoring system group, and to compare and verify the positive rate of diagnosis according to the diagnostic criteria or clinical diagnosis. Results Single factor analysis showed that the length of stay in the observation group was longer than that in the control group, and the proportion of indicators such as abdominal drainage tube, parenteral nutrition, central venous catheter, mechanical ventilation application>3 days, broad-spectrum antibiotics application>2 weeks, combination of two or more antibiotics, hypoproteinemia and glucocorticoid application>7 days were all higher than those in the control group, with statistical significance(P>0.05). Multiple-factor logistic regression analysis showed the length of stay, the combination of two or more antimicrobial agents, glucocorticoid application>7 days were independent risk factors for infant IFI in general surgery department. According to the regression coefficients of 2, 26 and 15, and the scoring system was established, the AUC of ROC curve was 0.880 (95% CI:0.825-0.935, P<0.001), and the cut-off value was 0.700. In other words, when the Z critical value was 63.5, the sensitivity was 0.778, and the specificity was 0.922. There was no statistical difference between the positive rate predicted by the scoring system in the verification group and the positive rate predicted by the diagnostic criteria or clinical diagnosis (P=0.074), Kappa=0.769, indicating a good consistency between the two methods. The sensitivity and specificity of the scoring system were 0.750 and 0.981, which were basically consistent with those of the cut-off value. Conclusion The effectiveness of the scoring system was good and its correctness had been verified, which had a good application value for early clinical identification of high-risk children with general surgery IFI.

Key words: invasive fungal infection, risk factor, infant and young children, general surgical department, scoring system

中图分类号:

R519

丁翔宇, 贾晨虹, 张古英, 李倩, 刘艳辉. 普外科婴幼儿侵袭性真菌感染的高危因素分析与评分系统建立[J]. 中国真菌学杂志, 2020, 15(6): 331-337,353.

DING Xiang-yu, JIA Chen-hong, ZHANG Gu-ying, LI Qian, LIU Yan-hui. A scoring system to predict the risk of invasive fungal infection in children of general surgical department[J]. Chinese Journal of Mycology, 2020, 15(6): 331-337,353.

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