(1,3)-β-D-葡聚糖检测对深部真菌感染的诊断意义  

Diagnostic value of plasma(1,3)-β- D- glucan detection for invasive fungal infection

作　　者：蒋伟[1] 周峥[1] 李少增[1] 于勇[1] 洪炜[2] 胡燕[2] 

机构地区：[1]中国人民解放军总医院第一附属医院,北京100048 [2]中国人民解放军第三0二医院

出　　处：《实用预防医学》2014年第1期89-91,共3页Practical Preventive Medicine

摘　　要：目的探讨血浆(1,3)-β-D-葡聚糖[(1,3)-β-D-Glucan,BDG]检测对深部真菌感染的诊断价值。方法回顾性分析430例疑似病例的BDG结果及其临床特征,应用MB-80微生物动态快速检测系统及GKT25M Set动态真菌检测试剂盒定量检测血浆中BDG的含量,结合患者血液、痰或中段尿标本的真菌培养,用统计学方法计算BDG试验在真菌感染早期诊断中的敏感性、特异性、阳性预测值和阴性预测值。同时连续检测血清BDG浓度变化,观察其与疾病进展和预后间的关系。结果 BDG检测法阳性135例,阳性率为31.4%;真菌培养法116例阳性,阳性率为26.9%。真菌培养阳性组的BDG含量为(91.85±25.26)pg/ml,真菌培养阴性组BDG含量为(30.69±10.95)pg/ml,两组血浆BDG浓度差异有统计学意义(t=2.349,P<0.05)。以真菌培养结果作标准,BDG的灵敏度为90.9%,特异性为77.4%。抗真菌治疗过程中,血清BDG水平在感染恶化患者持续升高,在治疗好转患者中明显下降。结论血浆BDG试验结果与临床侵袭性真菌诊断具有很好的一致性,与传统的真菌培养法相比,BDG检测简便、快速、阳性率高,可用于侵袭性真菌感染的早期快速诊断及疗效判断指标。Objective To explore the diagnostic value of plasma （ 1,3 ）-β- D - gluean in the detection of deep fungal infec- tion. Methods The BDG; results and clinical characteristics of 430 suspected patients were retrospectively analyzed. Blfo plasma concentration was detected by microbiology kinetic rapid detection system MB- 80 and kinetic mycete detection kit GKT25M set. Blood, sputum and urine fungal cultures were performed. The results were statistically analyzed. At the same time, continuous monitoring of dynamic change of BDG was conducted to observe the correlation between BDG concentration and disease progression and prognosis. Results There were 135 positive patients identified by the detection of plasma BDG, with the positive rate of 31.4%. 116 positive samples were identified by fungal cultures, with the positive rate of 26.9%. The con- centration of plasma IBI~ in invasive fungal infection group with positive fungal culture was （91.85 ~ 25.26） pg/mL, while the concentration of plasma BDG in invasive fungal infection group with negative fungal culture was （30.69 i 10.95） pg/ml. There were statistically significant differences in the concentration of plasma lBI~ between the two groups （ t = 2. 349, P 〈 0.05）. Ac- cording to the results of fungal cultures, the sensitivity and specificity of BDG were 90.9 % and 77.4 %, respectively. During the medication, the concentration of plasma BDG was continuously increased in deteriorating patients with the infection, but it was significantly decreased in convalescent patients. Conclusions The coherence and matching is very well between the r^sults of BDG detection and the diagnosis of deep fungal infection. BI~ detection is more convenient, faster and higher- positive- rate than fungal cultures, which can be used in the early diagnosis of deep fungal infection and the evaluation of therapeutic efficacy.

关 键 词：(1 3)8-β-葡聚糖 真菌 侵袭性感染 

分 类 号：R379[医药卫生—病原生物学]