1,3-β-D葡聚糖与半乳甘露聚糖检测对急诊非粒细胞缺乏症患者侵袭性真菌感染的诊断价值研究  

Diagnostic value of serum(1,3)-β-D-glucan and galactomannan assays for invasive fungal infection in non-neutropenic emergency patients

作　　者：杨婧[1] 刘善收[1] 李俊杰[1] 梁晓丽[1] 王仙琦 马妮[1] 虎晓岷[1] 

机构地区：[1]第四军医大学西京医院急诊科,西安710032

出　　处：《临床急诊杂志》2017年第10期772-774,共3页Journal of Clinical Emergency

基　　金：西京医院院内助推项目(No:XJZT15M08)

摘　　要：目的:目的1,3-β-D葡聚糖与半乳甘露聚糖在恶性血液病粒细胞缺乏症患者合并真菌感染的诊断中有重要价值,其对于非粒细胞缺乏患者的诊断价值却少有研究。本研究旨在了解1,3-β-D葡聚糖(G试验)与半乳甘露聚糖(GM试验)对急诊非粒细胞缺乏症患者侵袭性真菌感染的诊断价值。方法:收集2011-01-2017-01期间入住急诊重症监护室的真菌感染高危患者共378例,在抗真菌治疗前检测上述患者的血清G和GM抗原。结果:所有患者被分为确诊组(41例),临床诊断组(16例),拟诊组(59例),排除组(262例)。IFI患者最常见的基础病是糖尿病(21.38%),4.83%的患者无基础病。G试验、GM试验及G/GM试验至少一项阳性的敏感度、特异度、阳性预测值、阴性预测值分别为52.63%、77.86%、34.09%、88.31%;49.12%、87.78%、49.12%、89.86%和70.18%、75.57%、38.46%、92.09%。结论:与粒细胞缺乏症患者相比,单独检测血清G试验或GM试验对非粒细胞缺乏的IFI患者的诊断价值不大。但是,G试验及GM试验仅一项阳性对非粒细胞缺乏的IFI患者的诊断价值更大。Objective.. （1,3）-β-D-glucan （G） and Galactomannan （GM） are considered as useful serum markers for the diagnosis of invasive fungal infection （IFI） in hematologic malignancy patients with neutropenia. However, there is still limited data on these serum markers for testing emergency non-neutropenic patients who are at the risk of IFI. The aim of this study was to evaluate the diagnostic value of these two serum antigen assays for the early diagnosis of IFI in emergency patients without neutropenia. Method： Between January 2011 and January 2017, 378 patient with suspected IFI admitted to the emergency intensive care unit were prospectively monitored. Serum G and GM assays were performed before antifungal therapy. Result：Patients were classified as proven IFI （n= 41）, probable IFI （n=16）,possible IPA （n=59）,or non-IPA （n=262）. The most common underlying disease of patients with IFI was diabetes mellitus （21.38 % ）, and 4.83 % patients with IFI had no known diseases. The sensitivities,specificities,and positive and negative predictive values of the G and GM assays and at least one positive on both assays were 52. 63%/77. 86%34.09%/88. 31%if0,49. 12%/87. 78%/49. 12%/89. 86%, and 70. 18%/75. 57 %/38.46 %/92.09 %, respectively. Conclusion： Compared with the testing of neutropenic patients, the serum GM or BG assay alone was less useful for the diagnosis of IFI in non-neutropenic patients. However,at least one posirive result of the two serum assays seems to be useful in the diagnosis of IFI in non-neutropenic patients.

关 键 词：侵袭性真菌病 1 3-β-D葡聚糖 半乳甘露聚糖 诊断价值 

分 类 号：R55[医药卫生—血液循环系统疾病]