G试验联合真菌学检查对侵袭性真菌病的诊断价值分析  

Analysis of diagnostic value of G test combined with mycological examination on invasive fungal disease

作　　者：贺宇[1] 李红霞 付虹[1] 王蕊[1] 顾捷 HE Yu;LI Hong-xia;FU Hong(Department of Laboratory,Chengdu First People's Hospital,Chengdu Sichuan 610041,China)

机构地区：[1]成都市第一人民医院检验科,四川成都610041

出　　处：《临床和实验医学杂志》2021年第13期1437-1440,共4页Journal of Clinical and Experimental Medicine

基　　金：2017年四川省医学科研课题(编号:S17014)。

摘　　要：目的探讨(1,3)-β-D葡聚糖检测(G试验)联合真菌学检查对侵袭性真菌病(IFD)的诊断价值。方法回顾性收集2019年1月至2020年12月成都市第一人民医院高度疑似IFD的患者594例,住院期间均完成G试验及真菌涂片、真菌培养,其中104例还完成了隐球菌荚膜抗原检测。分析G试验、真菌学检查结果,并以临床诊断为金标准,计算各单项检测及联合检测对IFD的诊断效能。结果594例患者,确诊IFD 68例,拟诊18例,疑似95例,非IFD 413例。G试验诊断IFD(除隐球菌病)的敏感度、特异度分别为91.2%、63.9%,真菌涂片的敏感度、特异度分别为55.9%、96.4%,真菌培养的敏感度、特异度分别为75.0%、92.5%;3项联合应用的敏感度95.6%,明显高于真菌涂片、真菌培养(P<0.05),特异度为92.7%,明显高于G试验(P<0.05);且以3项联合的Youden指数最大为0.88。G试验诊断侵袭性隐球菌病的敏感度为66.7%,特异度为77.9%。结论G试验联合真菌涂片、真菌培养对IFD诊断的敏感度、特异度均较高,有助于IFD的早期诊断。Objective To explore the diagnostic value of(1,3)-β-D glucan test(G test)combined with mycological examination on invasive fungal disease(IFD).Methods A total of 594 patients with highly suspected IFD in Chengdu First People's Hospital were retrospectively collected between January 2019 and December 2020.G test,fungal smear and fungal culture were completed during hospitalization.Cryptococcal capsular polysaccharide antigen test was also completed among 104 cases.The results of G test and mycological examination were analyzed,and clinical diagnosis was taken as the gold standard to calculate the diagnostic efficacy of each single test and combined test on IFD.Results Among the 594 patients,there were 68 cases of diagnosed IFD,18 cases of proposed diagnosis,95 suspected cases and 413 cases of non-IFD.The sensitivity and specificity of G test in the diagnosis of IFD(except cryptococcosis)were 91.2%and 63.9%respectively.The sensitivity and specificity of fungal smear were 55.9%and 96.4%respectively,and the sensitivity and specificity of fungal culture were 75.0%and 92.5%respectively.The sensitivity of combination of the three(95.6%)was significantly higher than that of fungal smear or fungal culture(P<0.05),and the specificity(92.7%)was significantly higher than that of G test(P<0.05).The maximum Youden index of the combination of the three was 0.88,and the sensitivity and specificity of G test in diagnosing invasive cryptococcosis were 66.7%and 77.9%.Conclusion G test combined with fungal smear and fungal culture has high sensitivity and specificity in the diagnosis of IFD,and it is helpful for the early diagnosis of IFD.

关 键 词：侵袭性真菌病 (1 3)-β-D葡聚糖 真菌涂片 真菌培养 联合诊断 

分 类 号：R519[医药卫生—内科学]