多种检测指标对血液恶性肿瘤合并深部真菌感染患者的诊断价值  

Diagnostic value of multiple detection indicators in patients with hematological malignancies complicated with deep fungal infection

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,四川成都610075

出　　处：《实用检验医师杂志》2017年第2期73-76,共4页Chinese Journal of Clinical Pathologist

基　　金：成都中医药大学附属医院院基金(2014-D-YY-15)

摘　　要：目的评价血浆1,3-β-D葡聚糖、降钙素原(PCT)、超敏C反应蛋白(hs-CRP)单独及联合检测在早期诊断血液恶性肿瘤患者深部真菌病(IFD)中的价值。方法选择成都中医药大学附属医院血液科2014年10月年至2016年4月入院的非粒缺的血液恶性肿瘤确诊患者160例,其中合并侵袭性真菌感染患者80例为IFD组,细菌感染80例为对照1组,同时50例健康体检者为对照2组。检测血浆1,3-β-D-葡聚糖、PCT、hs-CRP诊断IFD时的受试者工作特征曲线(ROC曲线)及曲线下面积(AUC),敏感性、特异性,对3项指标进行相关性分析,探讨这几种方法联合诊断的价值。结果 IFD组1,3-β-D-葡聚糖均值为346.54 ng/L,显著高于细菌感染组47.27 ng/L(P<0.05)和健康对照组43.21 ng/L(P<0.05);IFD组PCT均值为1.18μg/L,显著低于细菌感染组16.3μg/L(P<0.05),高于健康对照组0.036μg/L(P<0.05);IFD组hs-CRP均值为59.6 mg/L,细菌感染组66.8 mg/L,两者水平差异无统计学意义(P>0.05),均显著高于健康对照组3.5 mg/L(P<0.05)。G试验单独诊断IFD的AUC、敏感性、特异性、阳性预测值、阴性预测值分别是0.91、90%、88.75%、85.71%、90.47%,针对血液恶性肿瘤IFD患者,最佳诊断阈值为≥70 ng/L时,诊断灵敏度为90%,特异性为88.75%;PCT单独诊断IFD的曲线下面积是0.82,针对血液恶性肿瘤IFD患者,最佳诊断阈值为1.65μg/m L,此时诊断灵敏度为81%,特异性为75.4%;hs-CRP单独诊断IFD的AUC是0.94,与细菌感染组AUC为0.92比较差异无统计学意义(P>0.05)。1-3-β-D-葡聚糖与PCT和hs-CRP的相关系数分别为0.764、0.334(P=0.003、P=0.048),血清联合组(1,3-β-D葡聚糖+PCT)灵敏度、特异性、阳性预测值分别为93%、90.2%、88.9%,均明显高于单一检测组。结论葡聚糖检测是一种快速、准确、简便的诊断IFD的方法,对于IFD的早期诊断有突出价值,PCT作为深部真菌感染的检测指标,可行性优于hs-CRP;葡聚糖联合PCT检测侵袭性真菌感染的诊断价值优Objective To evaluate the value of 1-3-β-D glucan, procalcitonin （PCT）, or high-sensitivity c-reactive protein （hs-CRP） individually or joint detection in the early diagnosis of hematology-oncology with deep fungal infection （IFD）. Methods The patients with hematologic malignancies, who admitted in hematology department from October 2014 to April 2016 were screened and enrolled. 160 patients were diagnosed with hematology-oncology, 80 patients with invasive fungal infection were set as assay group, the other 80 patients with bacterial infection as control group 1, and 50 healthy people were set as control group 2. The area under ROC curve, sensitivity and specificity of 1-3-β-D glucan, PCT, hs-CRP for IFD diagnosis was analyzed by linear correlation to explore the value of the joint diagnosis. Results 1-3-β-D glucan mean value of IFD group was 346.54 ng/L, significantly higher than 47.27 ng/L of the bacterial infection group （P 〈 0.05）and 43.21 ng/L of healthy control group （P 〈 0.05）; PCT mean value of IFD group was 1.18 μg/L, significantly lower than the bacterial infection group 16.3μg/L （P 〈 0.05） and higher than healthy control group 0.036 μg/L （P 〈 0.05）; hs-CRP mean value of IFD group was 59.6 mg/L, there was no statistically significant as compared to the bacterial infection group value of 66.8 mg/L（P 〉 0.05） but both were significantly higher than 3.5 mg/L of healthy control group （P 〈 0.05）; the IFD diagnostic results of the determining G, the area under the curve was 0.91, sensitivity was 90%, specificity was 88.75%, positive predictive value was 55.71% and negative predictive value was 90.47%, the best diagnostic threshold value should be equal or greater than 70 ng/L for the patients with hematologic malignancies, while the sensitivity was 90%, and specificity was 88.75%; the IFD diagnostic resuhs of PCT experiment, the area under the curve was 0.82, the best diagnostic threshold value should be equal or greater than 1.65 μg/L for the patients wi

关 键 词：血液肿瘤病 侵袭性真菌感染 1-3-β-D葡聚糖 降钙素原 超敏C反应蛋白 

分 类 号：R519[医药卫生—内科学] R730.43[医药卫生—临床医学] R733