支气管肺泡灌洗液（1，3）-β—D葡聚糖检测对重症监护病房患者侵袭性肺部真菌感染的诊断价值  

The value of assay of （1, 3）-β-D-glucan in bronchoalveolar lavage fluid for detection of invasive pulmonary fungal infection in critically ill patients in intensive care unit

作　　者：杨国辉[1] 盛忠燕[1] 

机构地区：[1]贵阳医学院附属医院内科ICU,贵州550004

出　　处：《中国危重病急救医学》2012年第2期90-95,共6页Chinese Critical Care Medicine

基　　金：贵州省省长专项基金项目[黔省专合字（2009）43]

摘　　要：目的探讨支气管肺泡灌洗液（BALF）检测（1，3）-β—D葡聚糖（G试验）在重症监护病房（ICU）患者侵袭性肺部真菌感染（IPVI）早期诊断及疗效判断的价值。方法入选2010年2月至2011年8月贵阳医学院附属医院内科ICU中怀疑IPFI患者。每周2次送检BALF、血清，行G试验及BALF真菌培养和镜检，记录培养、镜检及G试验阳性率及阳性时问、G试验的结果。按IPFI诊断标准回顾性分为确诊、临床诊断、拟诊及非IPFI感染对照组。G试验检测采用鲎试剂法；G试验阳性定义为连续2次不同时间点检测值／〉20ng／L。对BALFG试验阳性的患者给予氟康唑或伊曲康唑抢先抗真菌治疗，并于治疗7d、14d行BALF及血清G试验。结果共98例患者纳入本研究，IPFI确诊10例，BALFG试验阳性率90．O％；临床诊断29例，BALFG试验阳性率82．8％；拟诊32例，BALFG试验阳性率71．9％；非IPFI27例，BALFG试验阳性率7．4％。针对确诊及临床诊断者，BALFG试验阳性率84．6％（33／39），血清G试验阳性率59．0％（23／39），BALF曲霉菌培养阳性率41．0％（16／39），BALF镜检阳性率38．5％（15／39）；BALFG试验敏感性84．6％（33／39）、特异性92．6％（25／27）、阳性预测值94.3％（33／35）、阴性预测值80．7％（25／31），血清G试验敏感性58．9％（23／39）、特异性88．9％（24／27）、阳性预测值88．5％（23／26）、阴性预测值60．0％（24／40），二者敏感性比较差异有统计学意义（P〈0．05）。BALFG试验阳性时间早于真菌培养2～8d，平均（5．35±2．26）d。56例BALFG试验阳性患者有40例完成2周抗真菌抢先治疗，31例有效，9例无效死亡，病死率为22．5％。治疗有效组BALF、血清G试验结果（ng/L）呈下降趋势（BALF：245．13±43．84、174．00±13．01、28．52±7．38，血清：93．26±18．75、72．15±12．90、37．37±10．45．均P〈0．05），治疗无Objective To evaluate the value of （ 1, 3 ）-β-D-glucan （G test） in bronchoalveolar lavage fluid （BALF） in diagnosing and determining the therapeutic effects among the critically ill patients suspected with invasive pulmonary fungal infection （IPFI）. Methods Study was conducted between February 2010 and August 2011 in medical intensive care unit （ MICU ） of the Affiliated Hospital of Guiyang Medical College. Patients suspected of suffering from IPFI were enrolled. G tests of BALF and serum, and culture and microscopic examination of BALF were performed twice weekly. Clinical feature, mycological evidence and the results of G test were recorded. The results of IPFI were defined as ＂proven＂, ＂probable＂, ＂possible＂ and ＂non-IPFI＂. G test in BALF and serum was done with tachypleus amebocyte lysate. Positive G test was defined as cut-off index ≥20 ng/L in two consecutive measurements. Furthermore, the patients with positive G test received preemptive antifungal therapy with fluconazole or itraeonazole. G tests of BALF and serum were respectively done on 7th day and 14th day of treatment. Results Ninety-eight patients were included. Among them, 10 patients were ＂proven＂ in whom the positive rate of BALF G test was 90.0% ; 29 patients the results were considered as ＂probable＂ in whom the positive rate of BALF G test was 82.8% ; in 32 patients the results were ＂possible＂ IPFI in whom the positive rate of BALF G test was 71.9%, 27 patients were ＂non-IPFI＂ in whom the positive rate of BALF G test was 7.4%. The positive rate of BALF G test was 84.6% （33/39）, the positive rate of serum G test was 59.0% （23/39）, the positive rate of culture of BALF was 41.0% （16/39）, the positive rate of microscopic examination of BALF was 38.5% （ 15/39 ） in ＂proven＂ cases and ＂probable＂ cases. G test （cut-off 〉/20 ng/L） of BALF had shown to have sensitivity, specificity, positive predictive value （PPV） of 84.6% （33/39）, 92.6% （25/27）, 94.3% （33/

关 键 词：肺泡灌洗液 (1 3)-β—D葡聚糖 重症患者 侵袭性肺部真菌感染 

分 类 号：R519[医药卫生—内科学]