(1,3)-β-D葡聚糖检测联合其他微生物学检测在侵袭性真菌病诊断中的相关性分析  

Correlation analysis of (1,3)-β-D-glucan test combined with other microbiological tests in the diagnosis of invasive fungal disease

作　　者：杨金 朱均昊 李莉 章强强 YANG Jin;ZHU Junhao;LI Li;ZHANG Qiangqiang(Department of Dermatology,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院皮肤科,上海200040

出　　处：《中国感染与化疗杂志》2020年第3期277-281,共5页Chinese Journal of Infection and Chemotherapy

基　　金：国家自然科学基金(81573056)。

摘　　要：目的研究(1,3)-β-D葡聚糖检测(G 试验)联合真菌涂片、真菌培养及隐球菌荚膜抗原检测等微生物学检测在侵袭性真菌病(IFD)诊断中的临床意义。方法收集2018年2-12月在复旦大学附属华山医院同时进行G试验、真菌涂片、真菌培养的942例患者资料,其中184例另行隐球菌荚膜抗原检测。回顾性分析G试验、真菌检测和隐球菌荚膜抗原检测结果,分别计算不同检测方法及联合检测的灵敏度、特异度、阳性和阴性预测值。结果 942例患者中,确诊IFD 115例,拟诊33例,疑似154例,非感染640例。对除隐球菌病外的IFD诊断的灵敏度、特异度:G试验单独检测时为92.9%、59.0%;真菌涂片为57.5%、96.6%;真菌培养为77.9%、93.0%;三者联合检测时为97.3%、93.2%。对于隐球菌病,G试验灵敏度、特异度分别为77.1%、81.2%。结论 G试验灵敏度良好,特异度一般。将G试验与传统真菌学检测方法联合使用,能弥补单项检测不足,可作为辅助指标为临床及时正确诊断提供帮助。Objective To study the clinical significance of (1,3)-β-D-glucan test (G test) combined with fungal smear,fungal culture and cryptococcal capsular antigen assay in the diagnosis of invasive fungal disease (IFD).Methods Data were collected from 942 patients who underwent G test and mycological examinations at Huashan Hospital,Fudan University from February to December in 2018.A fraction of the patients (184/942) received additional test for cryptococcal capsular antigen.The results of G-test,mycological examinations and cryptococcal capsular antigen test were retrospectively analyzed.The sensitivity,specificity,positive and negative predictive values were calculated for different assays and the combined test panel.Results The diagnosis was proven IFD for 115 patients,probable IFD for 33 patients,and possible IFD for 154 patients.No fungal infection was found in the remaining 640 patients.The sensitivity and specificity of IFD diagnosis except cyptococcal disease were 92.9% and 59.0% by G test alone,57.5% and 96.6% by fungal smear,77.9% and 93.0% by fungal culture,and 97.3% and 93.2% by combined panel test.For cryptococcal disease,the sensitivity and specificity of G test were 77.1% and 81.2%,respectively.Conclusions G test alone has good sensitivity but poor specificity in identifying IFD.The combination of G test with traditional mycological assays can remedy the limitations of single test for accurate diagnosis of IFD in clinical practice.

关 键 词：(1 3)-β-D葡聚糖 侵袭性真菌病 联合检测 

分 类 号：R519[医药卫生—内科学]