支气管肺泡灌洗液G试验对慢性阻塞性肺疾病患者并发侵袭性肺部真菌感染早期诊断的价值  

Value of G test of bronchoalveolar lavage fluid in the early diagnosis of invasive pulmonary fungal infections in patients with chronic obstructive pulmonary disease

作　　者：蔡欣[1] 罗怡平[2] 梁政[3] 易震南[1] 

机构地区：[1]广东医学院附属医院呼吸内科,广东湛江524001 [2]广东医学院附属医院肿瘤科,广东湛江524001 [3]广东医学院附属医院心血管内科,广东湛江524001

出　　处：《新乡医学院学报》2016年第3期198-200,共3页Journal of Xinxiang Medical University

基　　金：湛江市科技攻关计划项目(编号:2013B01098)

摘　　要：目的探讨支气管肺泡灌洗液(BALF)中1,3-β-D-葡聚糖检测(G试验)对慢性阻塞性肺疾病(COPD)患者并发侵袭性肺部真菌感染(IPFI)早期诊断的价值。方法选择2012年1月至2014年4月广东医学院附属医院收治的COPD患者129例,采集患者BALF和外周静脉血进行G试验,采用流式细胞仪检测外周血CD3+CD4+细胞水平。结果 129例COPD患者中,并发IPFI患者69例(COPD并发IPFI组),未并发IPFI患者60例(单纯COPD组),IPFI发生率为53.5%(69/129)。COPD并发IPFI组和单纯COPD组患者的CD3+CD4+细胞水平分别为(32.91±1.15)%和(38.89±1.23)%,COPD并发IPFI组患者的CD3+CD4+细胞水平显著低于单纯COPD组(t=22.91,P<0.01)。肺功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级患者外周血CD3+CD4+细胞水平分别为(40.50±1.86)%、(37.85±1.75)%、(34.15±2.19)%、(31.8±1.65)%,不同肺功能分级患者外周血CD3+CD4+细胞水平比较差异有统计学意义(F=116.810,P<0.01)。COPD并发IPFI组患者BALF与血清G试验结果比较差异无统计学意义(χ2=0.307,P>0.05)。COPD并发IPFI组不同肺功能患者BALF和血清G试验定量结果比较差异均无统计学意义(BALF G试验:F=1.751,P>0.05;血清G试验:F=1.073,P>0.05)。结论 BALF G试验对COPD患者IPFI的早期诊断有较高的临床价值,且不受COPD患者肺功能影响。Objective To investigate the value of 1,3-β-D-glucosans detection（ G test） of bronchoalveolar lavage fluid（ BALF） in the early diagnosis of invasive pulmonary fungal infections（ IPFI） in patients with chronic obstructive pulmonary disease（ COPD）. Methods A total of 129 patients with COPD were selected from January 2012 to April 2014 in the Affiliated Hospital of Guangdong Medical University. The G test of BALF and peripheral venous blood was performed. The CD3＋CD4＋level of peripheral venous blood was detected by flow cytometer. Results Among 129 cases of COPD,69 cases with IPIF（ COPD ＋ IPFI group）,60 cases without IPFI（ COPD group）. The incidence of IPFI was 53. 5%（ 69 /129）. The level of CD3^＋CD4^＋in COPD ＋ IPFI group and COPD group was（ 32. 91 ± 1. 15） % and（ 38. 89 ± 1. 23） % respectively,the level of CD3^＋CD4^＋in COPD ＋ IPFI group was significantly lower than that in COPD group（ t = 22. 91,P 〈0. 01）. The level of CD3^＋CD4^＋in patients with Ⅰ,Ⅱ,Ⅲ,Ⅳ stage lung function was（ 40. 50 ± 1. 86） %,（ 37. 85 ± 1. 75） %,（ 34. 15 ± 2. 19） % and（ 31. 8 ± 1. 65） %,there was significant difference in CD3＋CD4＋level of peripheral blood among the patients with different lung function（ F = 116. 810,P 〈0. 01）. There was no significant difference in the result of G test of BALF and serum in COPD ＋ IPFI group（ χ^2= 0. 307,P 〉0. 05）. There was no significant difference in the quantitative result of G test of BALF and serum among the patients with different lung function in COPD ＋ IPFI group（ G test of BALF： F = 1. 751,P〉0. 05; G test of serum： F = 1. 073,P 〈0. 05）. Conclusion G test of BALF has high clinical value in the early diagnosis of IPFI in patients with COPD,and it is not affected by the lung function of patients with COPD.

关 键 词：支气管肺泡灌洗液 1 3-β-D-葡聚糖检测 侵袭性肺真菌感染 慢性阻塞性肺疾病 

分 类 号：R563[医药卫生—呼吸系统]