支气管肺泡灌洗液中G实验对侵袭性肺部真菌感染的诊断实用性  

Practicability of the （ 1,3 ） -β-D glucan in bronchoalveolar lavage fluid in diagnosis of invasive pulmonary fungal infection

作　　者：张文静[1] 张庆宪[1] 

机构地区：[1]郑州大学第一附属医院呼吸内科,450052

出　　处：《中国实用医刊》2017年第17期54-56,共3页Chinese Journal of Practical Medicine

摘　　要：目的 探讨支气管灌洗液中真菌葡聚糖检测（G试验）对诊断侵袭性肺部真菌感染（IPFI）的临床价值。 方法 选取肺部疾病患者134例，其中确诊或临床诊断为肺部真菌感染者32例，拟诊48例，非IPFI者54例。所有患者均行常规支气管肺泡灌洗，检测支气管肺泡灌洗液和血清中的真菌葡聚糖、半乳甘露聚糖数值，比较两种标本检测方法对侵袭性肺部真菌感染的临床实用性。 结果 32例患者有侵袭性真菌感染，其中卡氏肺囊虫肺炎10例，其支气管肺泡灌洗液G实验均为阳性（灵敏度为100%），尽管支气管肺泡灌洗液G实验与用于诊断侵袭性真菌感染的支气管肺泡灌洗液GM实验有相似的灵敏度，但其特异性比较低，而血清中真菌葡聚糖监测特异性高。 结论 支气管肺泡灌洗液中真菌葡聚糖监测呈现出低特异性，识别支气管肺泡灌洗液中干扰实验性能的特殊因素，可能会改善支气管肺泡灌洗液真菌葡聚糖监测的临床实用性。Objective To investigate the clinical practicability of the （1,3）-β-D glucan in bronchoalveolar lavage fluid in diagnosis of invasive pulmonary fungal infection （IPFI）. Methods A total of 134 patients with lung disease were selected, of which 32 cases were confirmed or clinically diag- nosed with pulmonary fungal infection, 48 patients were suspected cases, 54 cases were non IPFI. All patients were given normal bronchoalveolar lavage clysis, the contents of the （1,3）-β-D glucan and ga- lactomannan of the bronchoalveolar lavage fluid and serum were detected, the clinical practicability of the two methods for detection in diagnosis of invasive pulmonary fungal infection were compared. Results Thirty-two patients suffered invasive fungal infection, of which 10 cases of the patients were di- agnosed with pneumocystis carinii pneumpnia with G test of the bronchoalveolar lavage positive, the sen- sitivity was 100%, while bronchoalveolar lavage G test and GM test which were used for the diagnosis of invasive fungal infection had similar sensitivity, but specificity of broncho - alveolar lavage G test was lower. The specificity of dextran in serum was higher. Conclusions The （1,3）-β-D glucan test in the bronchoalveolar lavage fluid shows a low specificity, so identifying the special factors which will interfere the experimental performance may improve the clinical practicability of the （ 1,3 ） -β-D glucan in bron- choalveolar lavage fluid in fungal glucan monitoring.

关 键 词：侵袭性真菌感染 曲霉菌病 支气管肺泡灌洗液 

分 类 号：R519[医药卫生—内科学]