目的 比较四种真菌评分方法对侵袭性假丝酵母菌感染的诊断价值,为侵袭性假丝酵母菌感染早期诊疗提供依据.方法 回顾性分析2011-2016年某院重症监护病房(ICU)收治的侵袭性假丝酵母菌感染高危患者.依据诊断标准将患者分为非感染、拟诊、临床诊断和确诊4组,并对4组患者进行MDRA评分、IFIRSS评分、Sevilla评分及Candida评分,评价四种评分方法对侵袭性假丝酵母菌感染的诊断价值.结果 共有275例高危患者,非感染组138例,拟诊组63例,感染组74例(其中临床诊断组64例,确诊组10例).感染组患者年龄及住院时间均高于非感染组(均P＜0.05).74例感染患者共分离假丝酵母菌74株,主要为白假丝酵母菌60株(81.1％).MDRA评分阳性114例(41.5％)、Candida评分阳性83例(30.2％)、Sevilla评分阳性42例(15.3％)、IFIRSS评分阳性23例(8.4％).四种评分方法中MDRA评分灵敏度(Se)较高(59％),但特异度(Sp)最低(66％);IFIRSS评分Sp较高(91％),但Se极低(9％);Sevilla评分Sp最高(96％),Se尚可(45％);Candida评分的Se最高(68％),Sp较高(90％).结论 Sevilla评分有较高Se和Sp,可用于早期诊断侵袭性假丝酵母菌感染;Candida评分诊断侵袭性假丝酵母菌感染与临床诊断标准总符合率最高,Se、Sp均较高,对侵袭性假丝酵母菌感染早期诊断有较大价值.%Objective To compare diagnostic value of four fungal scoring methods in invasive Candida infection,provide evidence for early diagnosis and treatment of invasive Candida infection.Methods High-risk patients with invasive Candida infection in the intensive care unit(ICU) in a hospital from 2011 to 2016 were analyzed retrospectively.According to diagnostic criteria,patients were divided into four groups:non-infection group,suspected infection group,clinically diagnosed group,and confirmed group,patients were conducted multi-diseases risk assessment (MDRA) score,invasive fungal infections risk scoring system (IFIRSS) score,Sevilla score,and Candida score,diagnostic value of four scoring methods for invasive Candida infection were evaluated.Results There were 275 high-risk patients,138 in non-infection group,63 in suspected infection group,and 74 in infection group(clinically diagnosed group:n =64;confirmed group:n =10).The age and length of hospital stay in the infection group were all higher than non-infection group (both P＜0.05).74 strains of Candida were isolated from 74 infected patients,mainly Candida albicans (n =60,81.1％).Positive rates for MDRA score,Candida score,Sevilla score,and IFIRSSscore were 41.5％(n =114),30.2％(n =83),15.3％(n =42),and 8.4％ (n =23) respectively.Of four MDRA scoring methods,MDRA had the higher sensitivity(Se,59％) but lowest specificity(Sp,66％);IFIRSS had higher Sp(91％) but very low Se (9％);Sevilla score had the highest Sp (96％)and higher Se(45％);Candida score had the highest Se(68％) and higher Sp (90％).Conclusion Sevilla score has higher Se and Sp,which can be used in early diagnosis of invasive Candida infection;Candida score has the highest coincidence with clinical diagnostic criteria for invasive Candida infection,both Se and Sp are high,which is of great value for early diagnosis of invasive Candida infection.
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