真菌葡聚糖检测对血液恶性肿瘤患者早期深部真菌感染的诊断效能  

Clinical efficacy of fungal glucan detection for early diagnosis of invasive fungal infections in patients with hematological malignance

作　　者：李睿[1] 任然[1] 熊大迁[1] 

机构地区：[1]成都中医药大学附属医院检验科,成都市610075

出　　处：《实用检验医师杂志》2016年第3期142-145,共4页Chinese Journal of Clinical Pathologist

摘　　要：目的探讨血浆(1,3)-β-D-葡聚糖检测在早期诊断血液恶性肿瘤患者侵袭性真菌病(IFD)中的价值。方法选择成都中医药大学附属医院2014年10月年至2016年4月收治的非粒细胞缺乏血液恶性肿瘤患者进行筛选分组。确诊血液恶性肿瘤患者160例,其中80例确诊侵袭性真菌感染者为IFD组,非IFD患者80例。采用MB-80微生物动态快速检测系统测定IFD组和非IFD患者血浆(1,3)-β-D-葡聚糖含量,采用受试者工作特征曲线(ROC)评估G试验对IFD的诊断价值。结合真菌培养鉴定,统计不同类型真菌引起的深部感染(1,3)-β-D-葡聚糖水平的差异。结果 IFD组(1,3)-β-D-葡聚糖含量显著高于非IFD组(ng/L:346.54±204.95比43.21±15.11,P<0.05)。G试验单独诊断IFD的ROC曲线下面积(AUC)、阳性预测值、阴性预测值分别为0.91、86.71%、90.47%;针对血液恶性肿瘤IFD患者,最佳诊断阈值为≥70 ng/L时,诊断敏感度为90%,特异度为88.75%。G试验诊断IFD的时间较传统临床诊断明显缩短(d:4.87±2.55比7.13±4.42,P<0.01)。80例IFD患者40例分离出真菌,其中念珠菌属36株(占90%),(1,3)-β-D-葡聚糖均值为333.55 ng/L;曲霉菌4株(占10%),(1,3)-β-D-葡聚糖均值>1 000 ng/L。不同念珠菌之间(1,3)-β-D-葡聚糖水平比较差异无统计学意义(P>0.05),念珠菌属与曲霉菌属之间(1,3)-β-D-葡聚糖水平比较差异有统计学意义(P<0.05)。结论 (1,3)-β-D-葡聚糖检测是一种快速、准确、简便的诊断IFD方法,对于IFD的早期诊断有重要价值,对于区分念珠菌还是曲霉菌引发的深部真菌感染也有一定临床价值。Objective To discuss the value of plasma （1, 3）-β-D-glucan detection in the early diagnosis in invasive fungal disease （IFD） patients with hematological malignance. Methods The hospitalized patients with hematological malignance without neutropenia admitted to Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from October 2014 to April 2016 were enrolled. 160 hematological malignance patients were divided into different groups, 80 patients with invasive fungal, 80 patients with non-invasive fungal. Dynamic rapid microbial detection system MB-80 was used to detect plasma （1, 3）-β-D-glucan content, and the value of G test in the diagnosis of IFD was analyzed by receiver operating characteristic curve （ROC）. Combined with fungal culture identified, the difference of （1, 3）-β-D-glucan from various types of fungi induced deep infection was analyzed. Results The content of （1, 3）-β-D-glucan of IFD infected group was significantly higher than that of non-IFD infected group （ng/L： 346.54 ± 204.95 vs. 43.21 ± 15.11, P 〈 0.05）. In G test, the area under ROC curve （AUC） for IFD diagnosis was 0.91, positive predictive value was 86.71%, and negative predictive values was 90.47%. For patients with hematologic malignancies IFD, optimal diagnostic threshold was greater or equal to 70 ng/L, the diagnostic sensitivity was 90% and specificity was 88.75%, G test positive time for IFD diagnosis was significantly shorter than that of traditional diagnostic criteria （days： 4.87 ± 2.55 vs. 7.13 ± 4.42, P 〈 0.01）. Fungi was isolated from 40 patients, in which 36 were Candida, accounted for 90%, and （1, 3）-β-D-gluean mean was 333.55 ng/L; and 4 were Aspergillus, accountedfor 10%, and mean （1, 3）-β-D-glucan was greater than 1 000 ng/L. No significant difference was shown in （1, 3）-β-D-glucan among different Candida （P 〉 0.05）, but there was significant difference between Candida and Aspergillus groups （P 〈 0.05）. Conclusions （1, 3）-β

关 键 词：(1  3)-β-D-葡聚糖 血液肿瘤病 侵袭性真菌感染 真菌培养 

分 类 号：R446.5[医药卫生—诊断学] R733[医药卫生—临床医学]