真菌葡聚糖试验对侵袭性肺部真菌感染的诊断意义  

Diagnostic significance of yeast glucan test for invasive pulmonary fungal infections

作　　者：马原[1] 韩利红[1] 郑有光[1] 

机构地区：[1]郑州大学附属洛阳中心医院呼吸内科,河南洛阳471009

出　　处：《中华医院感染学杂志》2015年第13期2884-2885,2888,共3页Chinese Journal of Nosocomiology

基　　金：河南省医学科技基金资助项目(201004023)

摘　　要：目的探讨真菌葡聚糖试验对侵袭性肺部真菌感染(IPFI)的诊断意义及其临床价值,以期能为IPFI的诊治提供临床参考。方法选取2012年1月-2013年10月临床拟诊断为IPFI的住院患者60例为研究对象作为IPFI组,行支气管肺泡灌洗术;选取同期门诊健康体检人员60名为对照组,采集两组外周血,分别检测肺泡灌洗及血浆(1,3)β-D葡聚糖,收集患者痰液进行真菌培养。结果有3例患者手术送检组织病理检查确诊、54例痰液培养确诊、3例排除真菌感染为细菌感染,IPFI确诊者占拟诊的95.00%,感染真菌包括白色假丝酵母菌、曲霉菌属、热带假丝酵母菌等,分别占36.84%、17.54%、14.04%;观察组血浆及肺炎灌洗液检测(1,3)β-D葡聚糖值明显高于对照组(P<0.05),IPFI组肺泡灌洗液(1,3)β-D葡聚糖明显高于血浆检测值(P<0.05);感染真菌中曲霉菌属感染患者肺泡灌洗液、血浆(1,3)β-D葡聚糖检测值最高。结论真菌葡聚糖试验对IPFI诊断具有临床参考价值,如检测值较高可高度怀疑侵袭性肺曲霉病感染,但对其他真菌感染无法进行准确鉴别。OBJECTIVE To explore the significance and clinical value of yeast glucan test for the diagnosis of inva‐sive pulmonary fungal infections （IPFI） ,in order to provide clinical reference for the diagnosis and treatment of IPFI .METHODS Totally 60 hospitalized patients suspected with IPFI during Jan .2012 to Oct .2013 were selected as the research subjects and received bronchoalveolar lavage .The other 60 healthy subjects after outpatient physi‐cal examination during the same period were selected as the control group .Peripheral blood was collected from the two groups to detect （1 ,3）β‐D glucan in alveolar lavage fluid and plasma .Patients＇sputum was collected for cul‐ture .RESULTS Totally three patients were confirmed by surgical histopathological examination ,54 by sputum cul‐ture ,and 3 diagnosed as bacterial infection rather than fungal infection .Those confirmed with IPFI accounted for 95 .00% of the suspected ones .Infectious fungi included Candida albicans （36 .84% ） ,Aspergillus （17 .54% ） and Candida tropicalis （14 .04% ） .The （1 ,3）β‐D glucan level in plasma and pneumonia lavage fluid in the obser‐vation group was significantly higher than in the control group （P〈0 .05） .The （1 ,3）β‐D glucan level in alveolar lavage fluid was significantly higher than in plasma in the IPFI group （P〈0 .05） .The （1 ,3）β‐D glucan level in alveolar lavage fluid and plasma was the highest in Aspergillus infected patients .CONCLUSION Yeast glucan test has clinical reference value for IPFI diagnosis ,as invasive pulmonary Aspergillosis infection can be highly suspec‐ted if the detection level is high ,however ,other fungal infection cannot be accurately identified by the test .

关 键 词：(1  3)β-D葡聚糖 侵袭性肺部真菌感染 血浆 支气管肺泡灌洗液 

分 类 号：R446[医药卫生—诊断学]