真菌(1,3)-β-D-葡聚糖检测在早期诊断ICU肺侵袭性真菌感染中的临床价值  

Clinical value of fungal(1,3)-β-D-glucan detection in the early diagnosis of pulmonary invasive fungal infection in ICU

作　　者：汪艳[1] 沈翠芬[1] 夏森林[2] WANG Yan;SHEN Cuifen;XIA Senlin(Clinical Laboratory,Huzhou Central Hospital in Zhejiang Province,Huzhou 313000,China;Department of Emergency,Huzhou Central Hospital in Zhejiang Province,Huzhou 313000,China)

机构地区：[1]浙江省湖州市中心医院检验科,浙江湖州313000 [2]浙江省湖州市中心医院急诊科,浙江湖州313000

出　　处：《中国现代医生》2018年第7期122-124,128,共4页China Modern Doctor

基　　金：浙江省医学会临床科研基金(2016ZYC-A65)

摘　　要：目的探讨真菌(1,3)-β-D-葡聚糖检测(G试验)在早期诊断ICU肺侵袭性真菌感染(IFI)中的临床价值。方法选择2014年1月～2017年1月入住浙江省湖州市中心医院呼吸重症监护病房(RICU)和急诊重症监护病房(EICU)108例怀疑为肺部侵袭性真菌感染患者,根据出院时临床诊断分为IFI组(42例)和非IFI组(66例),使用G试验检测两组患者入院当天的真菌(1,3)-β-D-葡聚糖浓度,并与传统的真菌培养方法比较。结果 IFI组G试验值为(78.7±32.1)pg/mL,明显高于非IFI组(9.6±4.2)pg/mL,差异有统计学意义(P<0.01);IFI组患者中,G试验阳性率高达81.0%,高于真菌培养检验方法(66.7%),但差异无统计学意义(P>0.05);血浆G试验诊断IFI的灵敏度为81.0%、特异度为92.4%、阳性预测值为87.1%、阴性预测值为88.4%,而真菌培养方法的灵敏度为66.7%、特异度为80.3%、阳性预测值为68.3%、阴性预测值为79.1%。结论血浆(1,3)-β-D-葡聚糖检测(G试验)具有快速、准确、简易等特点,在ICU肺IFI早期诊断中具有较突出的临床价值。Objective To investigate the clinical value of fungal(1,3)-β-D-glucan detection(G test)in the early diagnosis of pulmonary invasive fungal infection(IFI)in ICU.Methods From January 2014 to January 2017,108 patients suspected of pulmonary invasive fungal infection who were admitted to Respiratory Intensive Care Unit(RICU)and Emergency Intensive Care Unit(EICU)in Huzhou Central Hospital of Zhejiang Province were selected.According to clinical diagnosis at discharge,the patients were divided into IFI group(n=42)and non-IFI group(n=66).The G test was used to detect the fungal(1,3)-β-D-glucan concentration on the day of admission in both groups,which was compared with the traditional fungal culture method.Results The G test value in IFI group was(78.7±32.1)pg/mL,which was significantly higher than that of(9.6±4.2)pg/mL in the non-IFI group,and the difference was statistically significant(P<0.01);the positive rate of G test in IFI group was 81.0%,which was higher than that of 66.7%in fungal culture test,but the difference was not statistically significant(P>0.05);the sensitivity of plasma G test in diagnosing IFI was 81.0%,specificity was 92.4%,positive predictive value was 87.1%,and negative predictive value was 88.4%.The sensitivity of fungal culture method was 66.7%,specificity was 80.3%,positive predictive value was 68.3%,and negative predictive value was 79.1%.Conclusion The plasma(1-3)-β-D-glucan detection(G test)is fast,accurate and simple.In the ICU pulmonary IFI early diagnosis,it has a more outstanding clinical value.

关 键 词：(1 3)-β-D-葡聚糖 G试验 肺侵袭性真菌感染 真菌培养 

分 类 号：R519[医药卫生—内科学]