真菌D-葡聚糖检测对COPD患者侵袭性肺部真菌感染的诊断及疗效评估价值  

The Diagnostic and Therapeutic Values of Fungal D-glucan Detection in COPD Patients with Invasive Pulmonary Fungal Infection

作　　者：周安文[1] 袁红霞[1] ZHOU Anwen;YUAN Hongxia(The First People's Hospital of Chenzhou City,Hunan Chenzhou 423000,China)

机构地区：[1]湖南省郴州市第一人民医院检验医学中心,湖南郴州423000

出　　处：《河北医学》2020年第7期1111-1115,共5页Hebei Medicine

基　　金：湖南省自然科学基金项目,(编号:17JJ6214)。

摘　　要：目的:探究真菌D-葡聚糖检测(G试验)对慢性阻塞性肺疾病(COPD)患者侵袭性肺部真菌感染(IPFI)的诊断及疗效评估价值.方法:选取2017年6月至2019年6月本院拟诊断为IPFI的COPD患者200例为研究对象,以真菌培养及涂片阳性结果作为金标准,所有患者行G试验检测,计算G试验对COPD患者IPFI的的灵敏度、特异度,分析其临床诊断价值并检测治疗有效及无效患者的D-葡聚糖含量.结果:200例拟诊断IP FI患者中,以真菌培养及涂片结果为标准,共检出阳性IP FI患者142例、阴性58例;而G试验共检出阳性IPFI患者132例,阴性患者68例.ROC曲线显示,G试验对COPD合并IPFI患者诊断的AUC分别为0.904,灵敏度为89.43%,特异度为91.38%,准确性较高.另治疗过程中,治疗有效者118例(83.10%),治疗无效者24例(16.90%).且经进一步的G试验值测定,治疗前两组测量值差异无统计学意义(P>0.05),治疗1、2周后,有效组的G试验测定值显著降低,差异具有统计学意义(P<0.05).结论:血浆G试验诊断真菌血流感染的准确性较高,对真菌血流感染的早期诊断具有较好的阳性预测价值,同时对于预测患者治疗效果有一定的临床指导意义.Objective:To explore the diagnostic and therapeutic value of fungal d-glucan test(G test)for invasive pulmonary fungal infection(IPFI)in patients with chronic obstructive pulmonary disease(COPD).Methods:200 patients with COPD diagnosed as IPFI from June 2017 to June 2019 in our hospital were selected as the research object.With fungal culture and smear positive results taken as the gold standard,all of the patients took G test,and sensitivity and specificity were calculated before analyzing the D-glucan content in valid and invalid cases.Results:Among the 200 patients to be diagnosed with IPFI,the results of fungal culture and smear were taken as the standard,and a total of 142 positive IPFI patients and 58 negative IPFI patients were detected.A total of 132 patients with positive IPFI and 68 patients with negative IPFI were detected by G test.The ROC curve showed that the AUC of G test for the diagnosis of COPD patients with IPFI was 0.904,the sensitivity was 89.43%,the specificity was 91.38%,and the accuracy was high.During the course of treatment,118 patients(83.10%)were treated effectively,while 24 patients(16.90%)were not treated effectively.Further measurement of G test value showed no statistically significant difference between the two groups before treatment(P>0.05).After 1 and 2 weeks of treatment,G test value of the effective group significantly decreased,with statistically significant difference(P<0.05).Conclusion:The accuracy of plasma G test in diagnosing fungal bloodstream infection is relatively high,which has a good positive predictive value for the early diagnosis of fungal bloodstream infection,and has certain clinical guiding significance for predicting the treatment effect of patients.

关 键 词：慢性阻塞性肺疾病 侵袭性肺部真菌感染 真菌D-葡聚糖检测 诊断价值 疗效评估 

分 类 号：R563.9[医药卫生—呼吸系统]