(1,3)-β-D-葡聚糖在不同证据级别的侵袭性肺曲霉病中的表现  

The presentation of plasma 1-3-β-D glucan in invasive pulmonary aspergillosis disease with different level of evidences

作　　者：张鑫强[1] 陈慧敏[1] 刘素玲[1] 凌勇[1] 叶龙[1] 赵越[1] 陈晓丽[1] 周典蓉 李正康[1] ZHANG Xin-qiang;CHEN Hui-min;LIU Su-ling(Department of Laboratory Medicine,Guangdong General Hospital,Guangzhou 510080,China)

机构地区：[1]广东省人民医院检验科广东省医学科学院

出　　处：《中国实验诊断学》2019年第11期1892-1896,共5页Chinese Journal of Laboratory Diagnosis

基　　金：广东省临床教学基地教学改革研究项目(2017JD124)

摘　　要：目的分析(1,3)-β-D-葡聚糖实验(G实验)在不同证据级别的侵袭性肺曲霉病中的表现。方法选取2014年1月-2017年12月在广东省人民医院诊断为侵袭性肺曲霉病的患者病例信息,收集患者临床信息:人口学资料、肺穿刺组织病理结果、呼吸道标本(痰、纤支镜冲洗液、肺泡灌洗液)培养结果、G实验结果。根据病理和培养的结果分为3组:病理+培养双阳性组、单培养阳性组、单病理阳性组。结果最后纳入分析的病例76例,男性46人,女性30人,平均年龄59±21岁。分组结果为:单病理阳性组39例(41.5%),病理+培养双阳性组10例(10.6%),单培养阳性组45例(47.9%)。3组的G实验阳性率有统计学差异(χ^2=9.34,P=0.036),进行两两比较发现,a调整为0.0125后,双阳性组的G实验阳性率显著高于单病理阳性组(χ^2=9.06,P1=0.004),G实验的中位值也是双阳性组最高(249.30pg/ml)。呼吸道标本培养最常见的是烟曲霉36例(占61.02%),其次是黄曲霉12例(占20.34%),但不同曲霉感染其G实验结果无统计学差异(H=4.021,P=0.403)。结论病理阳性的侵袭性肺曲霉患者其G实验的结果不一定高,最好结合培养结果进行诊断。Objective To explore the presentation of plasma 1-3-β-D glucan(G test)on t invasive pulmonary aspergillosis disease(IPA)with different level of evidences.Methods A retrospective study was conducted,the medical information of subjects who had been diagnosed as IPA was collected,such as demographic,Percutaneous lung biopsy,the culture results of respiratory tract specimen(Sputum,Bronchoscopic lavage and bronchoalveolar lavage)and G test.There were three groups based on the results of lung biopsy and culture:Group 1:Alone pathological positive group;2:Double positive group;Group 3:Alone culture positive.Results Total 76 patients were included(46male,30 female).The mean age was 59±21 years old.The numbers of patients in three different groups were 39(41.5%),10(10.6%),45(47.9%)from group 1to group 3.There were statistical differences among the three groups,The positive rate was compared in pairs adopted adjust P value(P1=0.0125),The Double positive group was significantly higher than Alone pathological positive group(χ^2=9.06,P=0.004).The highest median value of G test also been found in group 2(249.30pg/ml,P=0.007).the most common aspergillus was aspergillus fumigatus(36,61.02%),then was aspergillus flavus(12,20.34%).But there was no significantly difference in the value of G test between the three groups(H=4.021,P=0.403).Conclusion The plasma 1-3-β-D glucan test was not necessarily high for the IPA patients with Pathological positive,the culture method was necessary supplement to the diagnosis of IPA.

关 键 词：(1 3)-β-D-葡聚糖实验 侵袭性肺曲霉 临床应用 

分 类 号：R563.1[医药卫生—呼吸系统]