侵袭性肺曲霉菌患者血清半乳甘露聚糖动态变化及与CT影像学关系  

Dynamic changes of galactomannan and the relation with CT image in invasive pulmonary aspergillosis

作　　者：龚正[1] 占明[1] 张凌云[1] 龚萍 王艳华 崔聪[1] 王永全[1] 向光明[1] 陈世雄[1] 

机构地区：[1]三峡大学呼吸疾病研究所宜昌市中心人民医院三峡大学第一临床医学院,宜昌443000 [2]湖北省宜昌市秭归县人民医院,宜昌443600 [3]湖北省宜昌市兴山县人民医院,宜昌443700

出　　处：《中国真菌学杂志》2016年第4期205-208,共4页Chinese Journal of Mycology

基　　金：宜昌市医疗卫生科研基金(KFJ2013009)

摘　　要：目的观察侵袭性肺曲霉菌感染患者抗真菌治疗前后肺泡灌洗液及血清中半乳甘露聚糖(GM)的水平变化、CT影像学特征及血清中性粒细胞数与GM试验阳性率之间的关系,患者血清中性粒细胞值与GM试验阳性率之间的关系。方法连续性纳入60例确诊侵袭性肺曲霉菌感染患者,观察抗真菌治疗前后肺泡灌洗液和血清GM试验动态水平变化。单因素Logistic回归分析CT侵犯肺叶数、空气新月征、晕轮征、血清中性粒细胞值与GM的关系。结果抗真菌治疗前患者肺泡灌洗液GM平均值均高于血清GM平均值(0.62±0.08mg/L,60.0%;0.51±0.07mg/L,31.6%)。同抗真菌治疗前比,患者抗真菌治疗后1个月、2个月、3个月、6个月肺泡灌洗液GM值快速降低(P<0.05),而血清GM数值缓慢降低,仅在第3个月、第6个月降低(P<0.05)。患者CT侵犯肺叶数、晕轮征与肺泡灌洗液、血清中性粒细胞值GM试验阳性率显著相关。结论肺泡灌洗液及血清GM试验可作为IFD疾病诊断及治疗的重要辅助指标。CT影像学特征、血清中性粒细胞值与GM试验阳性率显著相关。Objective To observe changes of galactomannan（GM）in bronchoalveolar lavage（BAL）and serum,evaluate relationship between GM and CT feature,neutrophil count in serum for invasive fungal disease（IFD）.Methods Sixty patients with IFD and were enrolled in this study.The levels of GM were measured in BAL and serum.Univariate logistic regression analysis was performed with GM in BAL and lung lobe number,air crescent sign,halo sign,in CT feature and neutrophil in serum.Result GM in BAL was higher than the GM in serum（0.62±0.08 mg/L,60.0%;0.51±0.07 mg/L,31.6%）before antifungal treatment,compared with before antifungal treatment,the GM in BAL in 1m2m3m6 mdecreasd rapidly after antifungal treatment（P0.05）,but the GM of serum decrease slowly,decreasing only in 3m,6m（P0.05）.The positive rate of the GM of BAL was in concerned with the amount of invasive lung lobe and halo sign in CT and neutrophil count in serum.Conclusion GM in BAL might be a important marker for diagnosing and efficacy in IFD,GM in BAL was correlated with CT feature and neutrophil count.

关 键 词：侵袭性肺曲霉菌 肺泡灌洗液 半乳甘露聚糖 

分 类 号：R519.8[医药卫生—内科学]