1-3-β-D葡聚糖检测在艾滋病相关肺孢子菌肺炎诊断中的价值  

Value of 1-3-β-D glucan in diagnosis of AIDS-related Pneumocystis pneumonia

作　　者：李茜茜 叶宁 朱明利 叶荣夏 师金川 喻剑华 刘寿荣 包剑锋 

机构地区：[1]浙江中医药大学附属杭州西溪医院开放实验室,浙江杭州310023 [2]浙江中医药大学附属杭州西溪医院感染二科,浙江杭州310023

出　　处：《中华医院感染学杂志》2018年第2期161-164,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划基金资助项目(2015KYB321);杭州市社会发展基金资助项目(20160533B54)

摘　　要：目的探讨国产血浆1-3-β-D葡聚糖检测试剂在艾滋病合并肺孢子菌肺炎(PCP)诊断和疗效评估中的临床价值。方法选取医院2015年1月-2016年6月收治的65例艾滋病合并有肺部感染症状而无其他真菌感染的患者,根据《艾滋病诊疗指南第三版(2015版)》中肺孢子菌肺炎诊断标准,共甄选出27例艾滋病合并PCP的患者作为病例组,38例艾滋病合并其他肺部感染者为对照组,应用国产试剂检测患者入院时及治疗3周后血浆1-3-β-D葡聚糖浓度并进行统计分析。结果病例组血浆1-3-β-D葡聚糖浓度中位数40.15pg/ml,高于对照组的5.92pg/ml(P<0.001);受试者工作特征曲线(ROC)分析显示,血浆1-3-β-D葡聚糖用于诊断PCP的最佳诊断界值为16.51pg/ml,曲线下面积(AUC)为0.925(95%CI 0.864~0.985,P<0.001),此时敏感度和特异度分别为85.20%和86.80%;经3周治疗后病例组患者血浆1-3-β-D葡聚糖水平为4.28pg/ml,较前40.31pg/ml降低(P=0.005)。结论国产血浆1-3-β-D葡聚糖检测试剂对于诊断艾滋病合并肺孢子菌肺炎及评估其疗效具有较好的临床应用价值。OBJECTIVE To explore the clinical value of domestic plasma 1-3-β-D glucan test reagent in diagnosis of AIDS complicated with Pneumocystis pneumonia（PCP）and evaluation of curative effect.METHODS A total of 65 AIDS patients complicated with pulmonary infections who did not have other fungal infections and were treated in the hospital from Jan 2015 to Jun 2016 were enrolled in the study.According to the criteria for diagnosis of PCP in the Third Edition of the Guidelines for Diagnosis and Treatment of HIV/AIDS（2015）,27 AIDS patients complicated with PCP were screened out and assigned as the case group,and 38 AIDS patients complicated with other pulmonary infections were set as the control group.The concentration of plasma 1-3-β-D glucan was detected by using domestic test reagents at the admission to the hospital and after the treatment for 3 weeks,and the statistical analysis was performed.RESULTS The median concentration of plasma 1-3-β-D glucan of the case group was40.15 pg/ml,higher than 5.92 pg/ml of the control group（P〈0.001）.The analysis of receiver-operating-characteristic（ROC）curve indicated that the optimal threshold of the plasma 1-3-β-D glucan was 16.51 pg/ml in the diagnosis of PCP,the area under curve（AUC）was 0.925（95%CI 0.864~0.985,P〈0.001）,and the sensitivity and specificity were 85.20% and 86.80%,respectively.The plasma 1-3-β-D glucan level of the case group was 4.28 pg/ml after the treatment for 3 weeks,lower than 40.31 pg/ml before the treatment（P=0.005）.CONCLUSION The domestic plasma 1-3-β-D glucan test reagent has significant clinical value in diagnosis of AIDS complicated with PCP and evaluation of curative effect.

关 键 词：1-3-β-D葡聚糖 肺孢子菌肺炎 获得性免疫缺陷综合征 诊断 

分 类 号：R512.91[医药卫生—内科学]