血浆(1-3)-β-D葡聚糖对于尿路真菌感染的临床价值及危险因素分析  

Value of detection of plasma 1,3-β-D glucan in diagnosis of fungal urinary tract infections and analysis of risk factors

作　　者：严子禾[1] 胡锡池[1] 刘红玲[1] 

机构地区：[1]无锡市第二人民医院检验科,江苏无锡214002

出　　处：《中华医院感染学杂志》2013年第2期248-250,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨血浆(1-3)-β-D葡聚糖检测(G试验)对于尿路真菌感染的临床价值,同时分析尿路真菌感染的危险因素,为临床降低尿路真菌感染提供参考。方法选取2010年1月-2011年4月临床诊断为尿路真菌感染93例患者,81例非真菌感染者,52名健康体检者作为对照组,应用MB-80微生物动态快速检测系统和GKT-5MSet动态真菌检测试剂盒定量检测血浆(1-3)-β-D葡聚糖(BG)的含量,用ROC曲线评估G试验的诊断价值,同时用Kappa值检验G试验结果与培养结果的一致程度,用logistic回归建立模型进行危险因素分析。结果尿路真菌感染组BG 18.4pg/ml,显著高于非真菌组的7.5pg/ml和健康对照组的7.5pg/ml,ROC曲线分析显示,G试验临界值定为14.4pg/ml时,灵敏度、特异度、约登指数分别是91.00%、75.00%、0.66,可达最佳效果;G试验与培养一致性的Kappa值为0.583;单因素分析表明:中性粒细菌<0.5×109/L、长期使用广谱抗菌药物、BG含量与尿路真菌感染有相关性,多因素分析显示BG阳性、长期使用广谱抗菌药物为其预测因素。结论血浆BG可作为尿路真菌感染的早期预警指标,避免高危因素的发生,可有效减少尿路真菌感染的发生。OBJECTIVE To evaluate the value of the detection of the plasma 1,3-β- D. glucan（BG ） in diagnosis of the fungal urinary tract infections and assess the related risk factors for the fungal urinary tract infections so as to reduce the incidence of the urinary tract infections. METHODS From Jan 2010 to Apr 2011, a total of 93 patients who were diagnosed as the urinary tract infections and 81 patients with non-fungal infections were collected as the study objects, and 52 healthy subjects were set as the control group. G-test was used to measure the concentration of BG in the plasma by using MB-80 microorganism dynamic and rapid detection system and GKT-5M Set dynamic fungal detection kit. The cut-off points for BG were determined by using receiver operator characteristic curves （ROC） i while the consistency between the result of G-test and the culture result was examined by Kappa value,and the logistic regression analysis was performed to analyze the risk factors. RESULTS The concentration of BG in plasma of patients with the urinary system fungal infections （18.4 pg/ml ）was significantly higher than that of patients with non-fungal infections （7. 5 pg/ml） and healthy controls （7. 5 pg/ml）, the ROC curve analysis indicated that the best cut-off value was 14.4pg/ml, the sensitivity, specificity, and Youden index were 91.00 %, 75.00%, and 0.66, respectively. The Kappa value was 0. 583 as the G-test result was consistent with the culture result. The univariate analysis indicated that the neutrophils less than 0. 5 ×109/L, long-term use of broad spectrum antibiotics, and concentration of BG were related to the fungal urinary tract infections. The multivariate analysis showed that BG-positive and long-term use of broad spectrum antibiotics were the predictive factors. CONCLUSION The plasma BG can be used as early warning indicator for the fungal urinary tract infections. It is an effective way to reduce the incidence of fungal urinary tract infections by avoiding the high-risk factors.

关 键 词：血浆(1—3)-β—D葡聚糖 G试验 尿路真菌感染 诊断价值 

分 类 号：R446.1[医药卫生—诊断学]