降钙素原与(1,3)-β-D葡聚糖对肺部感染诊断的临床效能  

Clinical efficacy of procalcitonin and(1,3)-β-D-glucan for diagnosing pulmonary infection

作　　者：卢先雷[1] 罗宇鹏[1] 曹志跃 杨进[1] 朱文磊[1] 王平[1] 刘波[1] 朱勇[1] 孙长贵[2] 

机构地区：[1]成都市第五人民医院,四川成都611130 [2]中国人民解放军第117医院,浙江杭州310013

出　　处：《国际检验医学杂志》2015年第9期1200-1202,共3页International Journal of Laboratory Medicine

基　　金：四川省卫生厅科研基金课题项目(110048)

摘　　要：目的评价临床常规工作状态下降钙素原（PCT）与（1,3）-β-D葡聚糖（G试验）单独及联合应用诊断肺部感染的实际效能。方法收集病例1 027例,统计痰涂片及培养阳性分离菌分布组成,分别与微生物检验和胸部CT比对研究PCT和G试验的诊断价值,并研究微生物检验阳性与CT推断性诊断时G试验值分布,系统评价G试验与PCT联合应用对肺部感染的预测能力。结果病原菌分离以烟曲霉菌、多重耐药菌、结核分枝杆菌为主;与微生物检验比较时PCT特异性41.2%,敏感性66.4%;在微生物检验与CT均诊断为肺曲霉菌感染的病例中,G试验中位数与均数均小于临界值;与微生物检验比较,G试验特异性84.1%,敏感性13.2%;在一致病例中G试验中位值112.91,95%CI分布60∽768;CT为参照,G试验特异性75.0%,敏感性21.4%;疑似肺源性败血症病例中,PCT的中位值7.51,三个病例PCT低于阈值;三个病例G试验假阳性。两项检查同时阳性对肺部真菌感染的预测能力仅2.30%,对细菌感染为5.40%;大部分肺部真菌感染的患者PCT并不升高;某些细菌感染G试验也可能升高。结论对于PCT与G试验测定应该谨慎对待,合理分析,综合评价后有选择性的参考。Objective To evaluate the actual efficacy of single detection and combined detection of procalcitonin （PCT） and （1, 3）-β-D-glucan （G test） for diagnosing pulmonary infection under clinical routine working condition. Methods In 1 027 collected ca ses, the distribution and composition of positive isolated bacteria by sputum smear and culture were performed statistics,which was respectively compared with the microbiological test and chest CT for investigating the diagnostic value of PCT detection and G test. The G test value distribution in positive microbiological test and CT inferential diagnosis was also studied. The prediction capacity of the combined application of G test and PCT detection on pulmonary infection was systematically evaluated. Results The isolated pathogens were mainly aspergillus fumigatus,multidrug resistant organisms（MDROs） and mycobacterium tuberculosis（TB） ;compared with the microbiological test,the specificity of PCT detection was 41.2% and its sensitivity was 66.4% ;in the cases of lung aspergillus infection diagnosed by the microbiological test and CT, the median and mean of G test all were less than the critical value;compared with the microbiological test,the specificity of the G test was 84.1% and its sensitivity was 13.2% ;in the consistent cases,the median of the G test was 112.91,95% CI distribution was 60 768;with CT as the reference,the specificity of the G test was 75.0% and its sensitivity was 21.4% ;in the cases of suspected lung-derived septicemia, the median of the PCT detection was 7.51, PCT was lower than the threshold value in 3 cases;the G test was false positive in 3 cases. The prediction capacity of simultaneous positive in both two detections was only 2.30 % for lung fungal infection and 5.40 % for bacterial infection;in the most cases of lung fungal infection,PCT was not increased;in certain bacterial infection,the G test could be also increased. Conclusion The PCT detection and G test should be treated with caution and could serve as the selectiv

关 键 词：降钙素原 (1 3)-β-D葡聚糖 下呼吸道 感染 

分 类 号：R563.1[医药卫生—呼吸系统] R446.5[医药卫生—内科学]