血浆(1,3)-β-D葡聚糖检测对肺结核患者肺部真菌感染诊断价值的初步研究  

The preliminary study on the measurement of(1,3)β-D glucan in plasma for the diagnosis of pulmonary fungal infections in pulmonary tuberculosis patients

作　　者：胡族琼[1] 李雪雅[1] 胡琳燕[1] 竺澎波[1] 曹智忠[1] 邹彩容[1] 潘美玉[1] 

机构地区：[1]广东省广州市胸科医院检验科,510095

出　　处：《实用医学杂志》2017年第10期1615-1618,共4页The Journal of Practical Medicine

基　　金：广东省医学科研基金项目资助(编号:A2013530)

摘　　要：目的:探讨血浆(1,3)-β-D葡聚糖检测(G试验)对肺结核肺部真菌感染的诊断价值。方法:以2015年1-12月广州胸科医院收治的40例肺结核肺部真菌感染者为试验组,其中确诊者35例,拟诊5例。另选同期52例肺结核无肺部真菌感染者为对照组。测定两组患者血浆(1,3)-β-D葡聚糖含量,比较G值差异,G试验结果与病原学结果比较,分析G试验性能。结果:试验组真菌分布为白色念珠菌13株、曲霉菌属13株、热带念珠菌2株、光滑念珠菌2株、其他酵母菌6株。对照组病原学鉴定为真菌阴性。试验组与对照组G值分别为126.1和29.56 pg/m L(中位数),两组比较差异有统计学意义(P<0.001)。试验组G试验阳性35例,阴性5例;对照组G试验阴性41例,阳性11例。G试验敏感性、特异性、阳性预测值、阴性预测值及一致性分别为87.5%、78.85%、76.09%、89.13%、82.6%,约登指数为0.663。结论:肺结核患者肺部真菌感染白色念珠菌和曲霉菌属较常见。G试验诊断肺结核肺部真菌感染结果可靠、快速,敏感性、特异性和准确性较高。Objective To explore the measurement of （1,3）- β-D glucan in plasma for the diagnosis of pulmonary fungal infections in pulmonary tuberculosis patients. Methods 40 pulmonary tuberculosis patients with pulmonary fungal infections in Guangzhou chest hospital from January 2015 to December 2015 were enrolled as a test group, among which 35 were confirmed and 5 were suspected pulmonary fungal infections. 52 pulmonary tuberculosis patients without fungal infections were selected as a control group. （1,3）- β-D glucan content （G test） in this 92 patients plasma were detected. The results of G tests were compared with those from etiological diagnosis to assess the performance of G test. Results 13 strains of candida albicans, 13 strains of aspergillus, 2 strains of candida tropicalis, 2 strains of candida glabrata and 6 strains of other yeast were obtained from patients of test group, but no fungal identified from those of control group. The median of G test in test group and in control group was 126.1 and 29.56 pg/mL, respectively, the level in test group was significantly higher than that in control group （P 〈 0.001 ）. 35 cases were identified as positive and 5 were negative in test group by G test, while 41 cases were identified as negative and l 1 were positive in control group. The sensitivity, specificity, positive predictive value, negative predictive value, concordance and Youden index of G test were 87.5% , 78.85% , 76.09% , 89.13% , 82.6% and 0.663, respectively. Conclusions Candida albicans and aspergillus are more common pathogens than the other fungi isolated from pulmonary tuberculosis patients with pulmonary fungal infection. G test, used in pulmonary tuberculosis with pulmonary fungal infections diagnosis, is reliable and fast, and has a higher sensitivity, specificity and accuracy.

关 键 词：肺部真菌感染 (1 3)-d-D葡聚糖 肺结核 

分 类 号：R446.5[医药卫生—诊断学] R519[医药卫生—临床医学] R521