呼吸道标本病原学检测对曲霉菌诊断的价值  

Value of Respiratory Tract Pathogen Detection in Diagnosis of Aspergillosis

作　　者：陈益国[1] 邓林强[1] 陈会[1] 熊章华[1] 孙敬[1] 余理智[1] 

机构地区：[1]江西省人民医院检验科,南昌330006

出　　处：《南昌大学学报（医学版）》2014年第8期18-21,共4页Journal of Nanchang University：Medical Sciences

基　　金：国家自然科学基金(81360454);江西省自然科学基金(20132BAB205049)

摘　　要：目的探讨呼吸道标本直接涂片和培养对曲霉菌诊断的价值。方法将85例呼吸道标本(痰液、肺泡灌洗液)培养曲霉菌阳性患者按曲霉菌感染及曲霉菌定植诊断标准分为曲霉菌感染组(30例)和曲霉菌定植组(55例)。均采用卡方检验和二分类Logistic回归分析细菌培养联合标本直接革兰染色对区别曲霉菌感染和定植的诊断意义。结果 85例呼吸道合格标本曲霉菌培养和直接涂片阳性中,30例与临床诊断相符,符合率为35.2%。曲霉菌感染组镜下和培养检出正常菌群均显著低于定植组、曲霉菌检出次数显著高于定植组(均P<0.05)。2组镜下WBC浸润量、菌丝检出比较差异均无统计学意义(P=0.408,P=0.831)。经多因素Logistic回归分析示:曲霉菌检出次数、无正常菌群定植(包括镜下和培养均无正常菌群)对曲霉菌病诊断有统计学意义(P<0.05);激素使用、糖尿病、呼吸衰竭及血液系统疾病是其疾病发生的主要影响因素。在曲霉菌培养阳性基础上,镜下未见正常菌群对诊断灵敏度为83.3%,阴性预测值均达83.9%,培养未见正常菌群诊断灵敏度为86.7%、阴性预测值为89.4%,但特异度和阳性预测值均低于60.0%;两者联合诊断曲霉菌感染的特异度可提高到66.4%,阳性预测值可为53.9%。三者联合检测(镜下和培养未见正常菌群与检出次数)能提高曲霉菌诊断的特异度(92.0%)和阳性预测值(71.0%)。结论在标本合格条件下曲霉菌检出阳性时,呼吸道标本直接涂片及培养出正常菌群对区分曲霉菌定植与感染具有诊断价值。Objective To investigate the value of direct smear and culture of respiratory tract specimens in the diagnosis of aspergillosis.Methods Eighty-five patients with positive culture of Aspergillus from respiratory tract samples（sputum and bronchoalveolar lavage fluid）were divided into Aspergillus infection group（n=30）and Aspergillus colonization group（n=55）.The diagnos-tic significance of direct gram stain in the differentiation of Aspergillus infection and colonization was analyzed using chi-square test and binary logistic regression.Results Among the 85 patients, direct smear and culture results were consistent with the clinical diagnosis in 30（35.2%）.Com-pared with Aspergillus colonization group,normal flora detected by smear and culture significant-ly decreased but detection times obviously increased in Aspergillus infection group（P 〈 0.05）. There were no significant differences in white blood cell infiltration and mycelium detection be-tween the two groups（P =0.408,P =0.831）.Multiple logistic regression analysis showed that Aspergillus detection frequency and no normal flora colonization had statistical significance in the diagnosis of Aspergillosis（P 〈0.05）.Hormone use,diabetes,respiratory failure and blood disea-ses were the major factors influencing the occurrence of aspergillosis.On the basis of culture posi-tive for Aspergillus,both microscopic examination and uncultured normal flora detection provided＆amp;nbsp;a sensitivity of 83.3%,86.7%,respectively,and a negative predictive value of 83.9%,89.4%,for Aspergillus infection,respectiely.However,both specificity and positive predictive value were less than 60.0%.The specificity and positive predictive value of the combined microscopy and uncul-tured normal flora detection were 66.4% and 53.9%,respectively.The specificity and positive predictive value of the combined microscopy,uncultured normal flora detection and cultured nor-mal flora detection were 92.0% and 71.0%,respectively.Conclusion When the detection of As-pergillus

关 键 词：曲霉菌病 病原学检测 正常菌群 

分 类 号：R373[医药卫生—病原生物学]