白蛋白对血浆（1，3）-β-D-葡聚糖检测诊断侵袭性真菌感染的影响  

The effect of albumin on （1, 3）-β-D-glucan for diagnosis of invasive fungal infections

作　　者：韩世权[1] 苏晓蕾[1] 赵睿[1] 房开宇[1] 

机构地区：[1]大连市中心医院重症医学科,辽宁大连116033

出　　处：《中华危重病急救医学》2015年第8期672-676,共5页Chinese Critical Care Medicine

基　　金：辽宁省科研启动基金（20101023）

摘　　要：目的：探讨血浆（1，3）-β-D-葡聚糖检测（G试验）对侵袭性真菌感染（IFI）的诊断价值，及输注白蛋白对G试验的影响。方法采用前瞻性观察性研究方法，收集2012年1月21日至2014年10月31日大连市中心医院内科重症加强治疗病房（MICU）住院患者267例，根据IFI诊断标准将患者分为排除真菌感染组（35例）、拟诊组（70例）、临床诊断组（145例）、确诊组（17例）。使用MB-80微生物快速动态检测系统进行G试验检测。评估不同G试验临界值对IFI的诊断价值；比较G试验、真菌培养与临床诊断3种方法诊断IFI的差异；比较各组患者输注白蛋白前后G试验结果的变化，并评估输注白蛋白前后G试验对IFI的诊断价值。结果以20 ng/L为临界值，G试验诊断IFI的敏感度、特异度最高（分别为79.8%、87.9%），约登指数最大（为67.7%）。G试验、真菌培养与临床诊断IFI的阳性率分别为57.7%（154/267）、60.7%（162/267）与54.3%（145/267），两两比较差异均无统计学意义（均P＞0.05）。与输注白蛋白前比较，排除真菌感染组、拟诊组、临床诊断组、确诊组输注白蛋白后G试验检测值（ng/L）均无明显改变（排除真菌感染组：11.25±2.33比10.99±1.07，t＝-1.723，P＝0.085；拟诊组：53.14±5.53比49.22±8.11，t＝-0.395，P＝0.693；临床诊断组：90.30±9.38比85.41±10.11，t＝710.500，P＝0.860；确诊组：100.98±19.24比103.21±17.66，t＝653.000， P＝0.449）。输注白蛋白前，G试验诊断IFI的敏感度、特异度、阳性预测值（PPV）、阴性预测值（NPV）及约登指数分别为79.8%、87.9%、45.6%、96.7%、67.7%，而输注白蛋白后分别为81.5%、85.7%、44.8%、96.5%、67.2%，与输注前较为一致。结论 G试验可作为早期诊断IFI有效的检测手段，以20 ng/L为临界值可获得较好的敏感度与特异度，输注白蛋白不影响G试验检测结果。ObjectiveTo explore the diagnostic value of plasma （1, 3）-β-D-glucan test （G test） in diagnosis of invasive fungal infections （IFI） and the influence of albumin on G test.Methods A prospective observational study was conducted. 267 patients admitted to medical intensive care unit （MICU） of Dalian Municipal Central Hospital from January 21st, 2012 to October 31st, 2014 were enrolled. According to IFI guideline, the patients were divided into without IFI group （n= 35）, possible IFI group （n = 70）, hypotheticle IFI group （n = 145） and proven IFI group （n = 17）. G test was examined routinely using microbiology kinetic rapid reader MB-80.The different threshold values were calculated on G test. The difference among G tests, fungal culture and clinical diagnosis were compared. The results of G test ahead of and post albumin administration in each group were compared, and the value of G test for diagnosis of IFI during albumin infusion was evaluated.Results When the cut-off value was 20 ng/L for IFI diagnosis, higher sensitivity （79.8%）, specificity （87.9%）, and Youden index （67.7%） were found. The positive rates of G test, fungal culture and clinical diagnosis of IFI were 57.7% （154/267）, 60.7% （162/267） and 54.3%（145/267） respectively, without showing significant differences （allP〉 0.05）. The result of G test （ng/L） was not obviously changed after albumin administration compared with that before in without IFI, possible IFI, hypotheticle IFI, and proven IFI groups （without IFI group： 11.25±2.33 vs. 10.99±1.07,t= -1.723,P= 0.085; possible IFI group： 53.14±5.53 vs. 49.22±8.11,t= -0.395,P= 0.693; hypotheticle IFI group： 90.30±9.38 vs. 85.41±10.11, t= 710.500,P= 0.860; proven IFI group： 100.98±19.24 vs. 103.21±17.66,t= 653.000,P= 0.449）. Prior to the administration of albumin, sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV） and Youden index were 79.8%, 87.9%, 45.6%, 96.7%, 67.7%, respec

关 键 词：(1 3)-β-D-葡聚糖检测 侵袭性真菌感染 白蛋白 

分 类 号：R519[医药卫生—内科学]