荧光染色联合1,3-β-D葡聚糖检测对慢性阻塞性肺疾病并发真菌感染的诊断价值  

Diagnostic value of fluorescent staining combined with 1,3-β-D glucan test in chronic obstructive pulmonary disease complicated with fungal infection

作　　者：吴竞 许岩 方咏梅 张晶晶 章燕 钟峰 WU Jing;XU Yan;FANG Yong-mei;ZHANG Jing-jing;ZHANG Yan;ZHONG Feng(Department of Clinical Laboratory,the Second Affiliated Hospital of Wannan Medical College,Anhui Province,Wuhu241000,China)

机构地区：[1]皖南医学院第二附属医院检验科,芜湖241000

出　　处：《结核与肺部疾病杂志》2020年第3期140-143,共4页Journal of Tuberculosis and Lung Disease

基　　金：皖南医学院校级重点科研项目(WK2018ZF13)。

摘　　要：目的探讨荧光染色联合1,3-β-D葡聚糖检测(G试验)对慢性阻塞性肺疾病(COPD)并发侵袭性肺部真菌感染(IPFI)的诊断价值。方法搜集2019年1—12月皖南医学院第二附属医院确诊为COPD,且经广谱抗生素规范治疗5d后临床相关症状未能缓解,体温38℃未能下降或下降后复升的174例患者作为研究对象。将81例确诊IPFI者和拟诊IPFI者作为观察组,93例未并发IPFI者作为对照组。分析应用荧光染色检测研究对象痰液或肺泡灌洗液结果,及G试验和降钙素原(PCT)检测外周血的结果,比较各类检测技术的检测效能。结果采用受试者工作特征曲线(ROC曲线),以临床诊断结果为参照标准,荧光染色检测敏感度为81.6%,特异度为87.3%,均高于G试验(分别为81.5%和78.3%)和PCT检测(分别为74.9%和73.1%);荧光染色联合G试验检测的敏感度和特异度分别为96.2%和76.3%,阳性预测值和阴性预测值分别为83.1%和88.7%,曲线下面积(AUC)为0.894,明显优于所有单项检测效能。结论荧光染色法检测COPD并发IPFI具有较好的检测效能,其与G试验联合检测可有效提高诊断率。Objective To investigate the diagnostic value of fluorescent staining combined with 1,3-β-D glucan(G)test in chronic obstructive pulmonary disease(COPD)complicated with invasive pulmonary fungal infection(IPFI).Methods A total of 174 patients diagnosed with COPD in the Second Affiliated Hospital of Wannan Medical College from January to December 2019 who failed to relieve clinical symptoms and the body temperature did not drop at 38℃ or rose again after 5 days of standard treatment with broad-spectrum antibiotics were collected as subjects for the study.Eighty-one cases with confirmed IPFI and with proposed IPFI were taken as the observation group,and 93 cases without IPFI were taken as the control group.The results of sputum or alveolar lavage were analyzed by fluorescent staining,and the peripheral blood were detected by G test and procalcitonin(PCT).The detection efficiency of various detection techniques was compared.Results Based on the clinical diagnosis results as the reference standard,the receiver operating characteristic(ROC)curve analysis showed that the sensitivity and specificity of fluorescent staining were 81.6%and 87.3%,respectively,which were higher than those of G test(81.5% and 78.3%)and PCT test(74.9% and 73.1%).The sensitivity and specificity of fluorescent staining combined with G test were 96.2% and 76.3%,respectively,the positive predictive value and negative predictive value were 83.1% and 88.7%,respectively,and the area under the curve(AUC)was 0.894,which was significantly superior to all the individual detection efficiency.Conclusion Fluorescence staining method has good detection efficiency in detecting COPD accompanying with IPFI,and its combined with G test can effectively improve the diagnostic rate.

关 键 词：肺疾病 慢性阻塞性 肺疾病 真菌性 显微镜检查 荧光 β葡聚糖类 评价研究 

分 类 号：R563.9[医药卫生—呼吸系统] R519[医药卫生—内科学]