1,3-β-D-葡聚糖在真菌感染诊断及治疗中的应用  

Application of 1,3-β-D-glucan in the diagnosis and treatment of fungal infections

作　　者：崔建娇[1] 史际华[1] 陈冬梅[1] 朱勇[1] 

机构地区：[1]辽宁医学院附属第三医院检验科,辽宁锦州121001

出　　处：《中华医院感染学杂志》2014年第16期4155-4157,共3页Chinese Journal of Nosocomiology

基　　金：辽宁医学院临床基金资助项目(2011-62-20)

摘　　要：目的研究血浆中1,3-β-D-葡聚糖检测对诊断深部真菌感染以及治疗中监测临床应用价值,为临床诊断和治疗提供参考依据。方法对医院2011-2012年各临床科室可能发生真菌感染的140例患者行1,3-β-D-葡聚糖测定、普通细菌及真菌培养;按照实验室检测结果以及侵袭性真菌感染(IFI)诊断标准共分为4组:真菌培养阴性的非IFI组79例、真菌培养阳性的非IFI组9例、真菌培养阴性的IFI组10例、真菌培养阳性的IFI组42例,用Excel建立数据库,采用SPSS 13.0软件进行统计分析。结果非IFI组88例,葡聚糖含量中位数7.8pg/ml;IFI组52例,葡聚糖含量中位数59.3pg/ml;经秩和检验Z=-6.01,差异有统计学意义(P<0.05);葡聚糖在诊断IFI的特异性92.3%、敏感性93.1%、阳性预示值88.9%、阴性预示值95.3%;真菌培养在诊断IFI的特异性80.8%、敏感性89.8%、阳性预示值82.3%、阴性预示值88.8%;葡聚糖和真菌培养阳性率经χ2检验,差异有统计学意义(χ2=53.80,P<0.05)。结论在结合患者的临床表现和病原学检查的基础上,葡聚糖可以作为IFI的早期诊断指标,并且可以在IFI的治疗中进行动态监测的指标。OBJECTIVE To study the clinical application value of plasma 1,3-β-D-glucan detection for diagnosis and monitoring of deep fungal infection during treatment.METHODS Totally 140 patients who may have fungal infection in each department from 2011 to 2012underwent 1,3-β-D-glucan determination,ordinary bacterial culture,and fungal culture.According to the microbiology test results and the diagnosis standard for invasive fungal infection（IFI）,the patients were divided into four groups：the non IFI group with negative fungal culture（n=79）,the non IFI group with positive fungal culture（n=9）,the IFI group with negative fungal culture（n=10）,the IFI group with positive fungal culture（n=42）.A database was established with Excel and analyzed with SPSS 13.0.RESULTS There were 88 cases of deep fungal infections in the non IFI group,with median glucan content of 7.8pg/mL;and 52 cases in the IFI group,with median glucan content of 59.3pg/ml.With the rank sum test Z=-6.01,the difference was significant（P0.05）.Glucan had a specificity of 92.3%,a sensitivity of 93.1%,a positive prediction value of 88.9%,and a negative prediction value of 95.3% for the diagnosis of IFI.Fungal culture had a specificity of 80.8%,a sensitivity of 89.8%,apositive prediction value of 82.3%,and a negative prediction value of 88.8% for the diagnosis of IFI.The χ2 test showed the difference between glucan and the positive rate of fungal culture was significant（χ2=53.80,P0.05）.CONCLUSION On the basis of combination with clinical manifestations and etiology inspection,glucan can be used as the indicator for early diagnosis of IFI,and can be used as the dynamic monitoring indicator in the treatment of IFI.

关 键 词：深部真菌感染 1 3-Β-D-葡聚糖 真菌培养 

分 类 号：R446[医药卫生—诊断学]