G试验联合GM试验对恶性血液病患者伴侵袭性真菌病的诊断价值研究  

The diagnostic significance of G/GM assay for invasive fungal infections in patients with hematological malignancies

作　　者：童彤[1] 沈继录[1] 徐元宏[1] 王中新[1] 

机构地区：[1]安徽医科大学第一附属医院检验科,合肥安徽230032

出　　处：《中国微生态学杂志》2016年第10期1152-1156,1164,共6页Chinese Journal of Microecology

基　　金：国家自然科学基金(81171618)

摘　　要：目的探讨血浆(1,3)-β-D-葡聚糖检测(G试验)联合血浆半乳甘露聚糖检测(GM试验)对诊断恶性血液病患者伴侵袭性真菌病(IFD)的临床应用价值。方法收集安徽医科大学第一附属医院血液内科高危侵袭性真菌感染(IFI)病例193例,根据患者血浆G试验和GM试验的临床结果,分析其单项和联合检测时在IFD诊断中的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)。并同时分析GM试验结果在IFD患者治疗过程中的变化趋势。结果在血液肿瘤伴IFD的患者中,单独血浆G试验的检测敏感性、特异性、PPV和NPV分别是71.7%、89.3%、71.7%、89.3%。单独GM试验检测的敏感性、特异性、PPV和NPV分别是54.7%、94.3%、78.4%、84.6%。串联检测(两项同时阳性)的敏感性、特异性、PPV和NPV分别是39.6%、99.3%、95.5%、81.3%。并联检测(两项中任意一项阳性)的敏感性、特异性、PPV和NPV分别是86.6%、84.3%、67.7%、94.4%。17例GM试验阳性患者接受抗真菌治疗后,14例有效,3例无效。治疗有效组血浆GM值均从第2周开始下降,第3周降至正常水平,治疗无效组GM值持续升高,有效组和无效组差异有统计学意义(P<0.05)。结论血浆G试验和血浆GM试验对恶性血液病患者伴IFD有较高的临床诊断价值,两者联合检测的临床诊断价值进一步提高,可作为IFI诊断的指标之一;动态监测GM值有利于评估临床抗真菌治疗的疗效。Objective To explore the clinical significance of serum（1,3）-β-D-glucan and serum galactomannan for diagnosis of invasive fungal disease（IFD）in patients with hematological malignancies.Methods 193 patients with high risk invasive fungal infections（IFIs）from the department of hemopathology of our hospital were included.The sensitivity,specificity,positive predictive value（PPV）and negative predictive value（NPV）of（1,3）-β-D-glucan test and galactomannan test and the combination of both in the diagnosis of IFD were calculated.The change of galactomannan results during treatment was also analyzed in the patients who received antifungal therapy.Results The sensitivity,specificity,PPV,and NPV of（1,3）-β-D-glucan among IFD patients with hematological malignancies were 71.7%,89.3%,71.7% and 89.3% respectively,those of galactomannan test were 54.7%,94.3%,78.4% and 84.6% respectively,those of serial analysis were39.6%,99.3%,95.5% and 81.3% respectively,and those of parallel analysis were 86.6%,84.3%,67.7% and 94.4% respectively.17 galactomannan positive patients received antifungal therapy;14responded to the treatment while 3did not.The galactomannan value in the effective group decreased from the second week and reached to normal level in the third weeks,while that in the ineffective group continued to increase.There was statistical difference between the effective group and ineffective group（P〈0.05）.Conclusion Serum（1,3）-β-D-glucan and serum galactomannan assay as the diagnostic indexes of IFD can provide a strong evidence for early diagnosis of IFI in patients with hematological malignancies,and combined diagnosis can provide more valuable clinical value.Dynamic monitoring of galactomannan is useful for assessing the efficacy of clinical antifungal therapy.

关 键 词：(1 3)-β-D-葡聚糖 半乳甘露聚糖 侵袭性真菌感染 侵袭性真菌病 

分 类 号：R446.53[医药卫生—诊断学]