支气管肺泡灌洗液（1，3）-β-D葡聚糖检测对肺部真菌感染诊断价值的初步研究  

A preliminary study on the measurement of （1, 3 ）-β-D-glucan in bronchoalveolar lavage for the diagnosis of pulmonary fungal infections

作　　者：杨文柳[1] 曹洁[1] 陈宝元[1] 谢巍[1] 董丽霞[1] 吴月清[1] 李津娜[1] 胡志东 

机构地区：[1]天津医科大学总医院呼吸科,300052 [2]细菌室

出　　处：《中华结核和呼吸杂志》2012年第12期897-900,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的探讨BALF中（1，3）-β-D葡聚糖检测对肺部真菌感染的诊断价值。方法选择2010年2月至2011年2月天津医科大学总医院收治的135例患者，其中确诊或临床诊断肺部真菌感染患者34例，单纯肺炎患者53例，非感染患者48例。所有患者均行支气管肺泡灌洗，检测BALF和血浆中（1，3）-β-D葡聚糖含量（G试验），对数据进行独立样本秩和检验并绘制受试者工作曲线（ROC曲线），确定2种G试验诊断真菌感染的最佳临界值。结果BALF的G试验结果真菌感染组、单纯肺炎组和非感染组分别为281、28和10ng／L（中位数，四分位间距），真菌感染组明显高于其他2组（U值分别为134和147，P〈0．001），单纯肺炎组和非感染组比较差异无统计学意义（U=904，P〉0．05）。血浆G试验结果真菌感染组、单纯肺炎组和非感染组分别为27、10及5ng／L（中位数，四分位间距），真菌感染组明显高于其他2组（P〈0．001），单纯肺炎组和非感染组比较差异无统计学意义（P〉0．05）。BALF的G试验诊断真菌感染的最佳临界值为67ng／L，血浆G试验诊断真菌感染的最佳临界值为17ng／L。结论BALF的G试验较血浆G试验诊断侵袭性肺部真菌感染可能更早、更准确，有较高的潜在临床应用价值。Objective To explore the measurement of （1,3）-β-D -glucan bronchoalveolar lavage fluid （BALF） for the diagnosis of pulmonary fungal infections. Methods A total of 135 patients in the General Hospital of Tianjin Medical University from February 2010 to February 2011 were enrolled. There were 34 cases of confirmed or clinically diagnosed pulmonary fungal infections, 53 cases of bacterial pneumonia , and 48 cases of non-infection diseases. All patients underwent BAL and the BALF samples were obtained. （ 1,3 ） -β-D-glucan content （ G test）, in BALF and plasma were tested and the data were analyzed statistically by Mann-Whitney while the receiver operating characteristic curve （ ROC curve） was established, from which the best threshold of the 2 G tests was derived. Results The median of BALF G test in the fungal infection group, pneumonia group and non-infection group was 281, 28 and 10 ng/L, respectively ; the level in the fungal infection group being significantly higher than those of the other 2 groups （P 〈 0. 001 ）, but no significant difference being observed between the pneumonia group and the non- infection group （P 〉 0. 05 ）. The median of plasma G tests in the fungal infection group, the pneumonia group and the non-infection group was 27, 10, and 5 ng/L, respectively; the level in the fungal infection group being significantly higher than those in the other 2 groups （ P 〈 0. 001 ）, but there was no significant difference between the pneumonia group and the non-infection group （ P 〉 0. 05 ）. The best threshold of BALF G test was 67 rig/L, while the best threshold of G test of plasma was 17 ng/L. Conclusion As compared to G test of plasma, G test of BALF may be more accurate, and have a higher clinical value for the earlier diagnosis of pulmonary fungal infections.

关 键 词：真菌 感染 肺部支气管肺泡灌洗液 13葡聚糖类 

分 类 号：R519[医药卫生—内科学]