血浆(1,3)-β-D-葡聚糖对重症监护病房侵袭性真菌病的诊断价值  

The significance of a plasma(1,3)-β-D-glucan for early diagnosis of invasive fungal infections in intensive care units

作　　者：刘盛敏[1] 梁瑛[1] 

机构地区：[1]北京丰台医院呼吸科,100071

出　　处：《心肺血管病杂志》2012年第2期150-154,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:评价(1,3)-β-D-葡聚糖(BG)对重症监护病房(ICU)患者侵袭性真菌病(IFI)的诊断价值,探讨其最佳诊断界值。方法:2007年12月至2009年1月对北京安贞医院各ICU病房怀疑IFI的45例危重症患者的血浆标本,进行(1,3)-β-D-葡聚糖浓度检测(G实验)。筛选出23例确定诊断和临床诊断的IFI患者,设为IFI组;16例真菌口腔定植者或非IFI患者设为对照组。结果:1.IFI组患者血浆(1,3)-β-D-葡聚糖浓度的中位数为30.37 ng/L(范围5.0～225.7 ng/L),对照组患者血浆(1,3)-β-D-葡聚糖浓度的中位数为5.0 ng/L(范围5.0～78.7 ng/L),经2个独立样本秩和检验,2组(1,3)-β-D-葡聚糖浓度的差异有统计学意义(P=0.001),IFI组明显高于对照组。2.血浆(1,3)-β-D-葡聚糖浓度诊断IFI的ROC曲线下面积为0.852(P=0.0001),95%的置信区间为0.712～0.992。以14.02 ng/L为诊断阈值,敏感性和特异性较理想。其诊断的敏感性、特异性、阳性预计值(PPV)和阴性预计值(NPV)分别是82.6%、87.5%、90.4%和77.8%,一致性检验Kappa值为0.688(P=0.001)。结论:G试验可以作为ICU中IFI的诊断方法之一。以14.02 ng/L为诊断界值时有较理想的敏感性和特异性。Objective：To evaluate the significance of a plasma（1,3）-β-D-glucan（BG） for early diagnosis of invasive fungal infections（IFIs） and determine its cutoff in intensive care units（ICUs）.Methods： Plasma of patients with suspected IFI were collected at least 1 time from December 2007 to January 2009 in medical and surgical ICUs of Beijing Anzhen hospital.The patients were split into two groups： group IFI comprised 23 patients with proven and probable IFI.Group control comprised 16 patients without fungal infection or with oral fungal colonization.Plasma BG levels were measured by GKT-5M Set.Compared to the concentrations of the two group and calculated the sensitivities and specificities of the assay according to different G-Test positive criteria and determined its cutoff.Results： 1.The median concentration of（1,3）-β-D-glucan（BG） in plasma of patients with IFI 30.37 ng/l（5.0-225.7 ng/l）was significantly higher than that of control groups 5.0 ng/L（5.0-78.7 ng/L）,（P0.001）.2.The area under ROC curve of BG assay for the diagnosis of IFI is 0.852（P=0.001）,95% confidence interval is 0.712-0.992.When 14.02 ng/L was taken as cutoff value,The sensitivities and specificities,positive predictive value（PPV） and negative predictive value（NPV） of BG were 82.6%,87.5%,90.4% and 77.8% respectively,with Kappa value of 0.588（P=0.001）.Conclusion： The G-Test was one of most useful methods to diagnose IFI in ICU,which was convenient、shortcut and had a high diagnose accordance rate.If 14.02 ng/L was taken as cutoff value,the sensitivities and specificities were ideal.It worth to make more widespread in hospital.

关 键 词：(1 3)-β-D-葡聚糖 侵袭性真菌感染 重症监护病房 

分 类 号：R56[医药卫生—呼吸系统]