支气管肺泡灌洗液G试验对儿童重症监护病房侵袭性肺部真菌感染诊断价值研究  

The clinical value of assay of G test in bronchoalveolar lavage fluid for detection of invasive pulmonary fungal infection in critically ill patients in pediatric intensive care unit

作　　者：谢友军 莫武桂[1] 唐育鹏[1] 韦蓉[1] 韦跃[1] 李洁[1] 傅君[1] 卢功志 

机构地区：[1]广西壮族自治区妇幼保健院PICU,广西南宁530000

出　　处：《中国实用儿科杂志》2015年第3期211-214,共4页Chinese Journal of Practical Pediatrics

摘　　要：目的探讨支气管肺泡灌洗液(BALF)G试验检测在儿童重症监护病房(PICU)侵袭性肺部真菌感染(IPFI)中的临床价值。方法收集2012年12月至2013年6月在广西壮族自治区妇幼保健院PICU病房治疗,高度怀疑为IPFI的患儿60例。均行BALF、血清G试验检测,比较两者的阳性率,根据结果对阳性患儿行抢先氟康唑抗真菌治疗,疗效不佳者根据BALF培养结果或临床经验改予伏立康唑、伊曲康唑、两性霉素B等抗真菌治疗,并分别于抗真菌治疗7 d、14 d后复查并分析其变化趋势。结果 BALF G试验阳性率(88.3%,53/60)明显高于血清G试验阳性率(30%,18/60)(χ2=29.64,P<0.01)。抗真菌治疗有效组患儿治疗7 d、14 d后的BALF及血清G试验结果(ng/L)与治疗前比较有明显降低趋势(BALF:698.33±213.86,490.03±157.79,207.07±66.19,血清:338.50±109.15,222.86±59.72,103.89±27.47),结果两两比较差异均有统计学意义(F值分别为204.69、61.18,均P<0.01)。结论BALF G试验在PICU病房高度怀疑为IPFI患儿中的检出率很高,可用于IPFI的早期诊断,且动态监测其变化可用于抗真菌治疗临床疗效的评价。ObjectiveTo evaluate the value of G test in bronchoalveolar lavage fluid（BALF）among the critically illpatients who were highly suspected with invasive pulmonary fungal infection（IPFI）in Pediatric Intensive Care Unit（PI-CU）.MethodsA total of 60 patients highly suspected with invasive pulmonary fungal infection（IPFI）in PICU ofGuangxi Maternal and Child Health Hospital were enrolled. All patients underwent G test in BALF and serum. Comparethe positive rate;the positive patients received preemptive antifungal therapy with fluconazole,and for the poor efficacyafter the treatment,fluconazole was changed to voriconazole,itraconazole,amphotericin B and other antifungal therapybased on BALF culture results or clinical experience.Review the results and analyze the trends on 7th day and 14 th dayafter antifungal treatment.ResultsThe positive rate of BALF G test was 88.3%（53/60）,significantly higher than thatof serum G test（30%,18/60）（χ^2=29.64,P〈0.01）. After treatment on 7th day and 14 th day,the result of G test inBALF and serum（ng/L）was significantly lower than that before the treatment（BALF：698.33±213.86,490.03±157.79,207.07 ± 66.19;serum：338.50 ± 109.15,222.86 ± 59.7,103.89 ± 27.47）. The differences of Pairwise comparisons werestatistically significant（F values were 204.69,61.18,all P〈0.01）.ConclusionBALF G test has a high detectionrate among the patients highly suspected with invasive pulmonary fungal infection（IPFI）in Pediatric Intensive Care Unit（PICU）,and it may be an useful test for early diagnosis of IPFI.Moreover,the dynamic change in G test values could beuseful for assessing antifungal therapeutic response.

关 键 词：支气管肺泡灌洗液 G试验 儿童重症监护病房 侵袭性肺部真菌感染 

分 类 号：R72[医药卫生—儿科]