(1-3)-β-D葡聚糖及血小板水平诊断马尔尼菲篮状菌病的临床价值  

Clinical value of(1-3)-β-D-glucan and platelet levels in diagnosis of patients with Talaromycosis Marneffei

作　　者：陈涛[1] 蒋忠胜[1] 兰慧慧 李敏基[1] 覃锦玉 莫胜林[1] 覃川[1] CHEN Tao;JIANG Zhongsheng;LAN Huihui;LI Minji;QIN Jinyu;MO Shenglin;QIN Chuan(Department of Infectious Diseases,Liuzhou General Hospital,Liuzhou 545006,China;Department of Respiratory Medicine,Longtan hospital of Guangxi Zhuang Autonomous Region,Liuzhou 545004)

机构地区：[1]广西柳州市人民医院感染病科,广西柳州545006 [2]广西壮族自治区龙潭医院呼吸内科,广西柳州545004

出　　处：《中国艾滋病性病》2021年第12期1343-1347,共5页Chinese Journal of Aids & STD

基　　金：“十三五”国家科技重大专项课题(2018ZX10302104-001-008);柳州市科技计划项目资助课题(2021CBC0107);广西卫生厅课题(Z20200297,Z20180286);柳州市人民医院院内课题(lry201707)。

摘　　要：目的探讨(1-3)-β-D葡聚糖及血小板(PLT)水平对AIDS患者发生消化道出血(GIB)时,诊断马尔尼菲篮状菌病(TSM)的临床价值。方法回顾性分析柳州市人民医院2009年1月至2021年1月收治的100例HIV感染者,观察组51例为临床确诊TSM并发GIB者,对照组49例为无机会性感染者。比较两组(1-3)-β-D葡聚糖及PLT水平,通过ROC曲线评估并定义诊断TSM的最佳诊断条件。选取广西龙潭医院2015年1月至2021年1月收治的60例HIV感染者作为验证对象,验证最佳诊断条件对TSM的临床诊断价值。结果 PLT水平对照组高于观察组[105.0(86.0,132.5)×10^(9)/L vs. 55.0(31.0,76.0)×10^(9)/L],PLT异常率对照组低于观察组[36.73%vs. 98.04%]。(1-3)-β-D葡聚糖水平对照组低于观察组[20.40(1.00,92.79)pg/mL vs. 272.80(116.70,579.80)pg/mL],(1-3)-β-D葡聚糖阳性率对照组低于观察组[28.57%vs. 86.27%],差异均有统计学意义(P均<0.05)。ROC曲线分析结果提示PLT和(1-3)-β-D葡聚糖诊断TSM的cut-off值为72.5×10^(9)/L和83.21pg/mL。当PLT≤72.5×10^(9)/L且(1-3)-β-D葡聚糖≥83.21 pg/mL时,用于诊断TSM的敏感度、特异度、阳性预测值、阴性预测值分别为86.67%、90.00%、89.66%和87.10%。结论当AIDS患者发生消化道出血时,若患者PLT≤72.5×10^(9)/L且(1-3)-β-D葡聚糖≥83.21pg/mL,需高度警惕存在TSM可能。Objective To explore Clinical value of(1-3)-β-D-glucan and platelet(PLT) levels in the diagnosis of marneffei basket Mycosis(TSM) in AIDS patients with gastrointestinal bleeding(GIB). Methods 100 cases of HIV infection treated in Liuzhou people’s Hospital from January 2009 to January 2021 were analyzed retrospectively. 51 cases in the observation group were clinically diagnosed with TSM complicated with GIB, and 49 cases in the control group were an inorganic infection. Compare the two groups The levels of(1-3)-β-D-glucan and PLT were evaluated and defined by the ROC curve. 60 HIV-infected persons treated in Guangxi Longtan hospital from January 2015 to January 2021 were selected as verification objects to verify the clinical diagnostic value of the best diagnostic conditions for TSM. Results the PLT level in the control group was higher than that in the observation group [105.0(86.0, 132.5)×10^(9)/L vs. 55.0(31.0,76.0) ×10^(9)/l], the abnormal rate of PLT in the control group was lower than that in the observation group[36.73% vs. 98.04%]. The level of(1-3)-β-D-glucan in the control group was lower than that in the observation group [20.40(1.00, 92.79) pg/ml vs. 272.80(116.70,579.80) pg/ml], The positive rate of(1-3)-β-D-glucan in the control group was lower than that in the observation group [28.57% vs. 86.27%], and the difference was statistically significant(P<0.05). ROC curve analysis results suggest PLT and The cut-off value of(1-3)-β-D-glucan for diagnosing TSM was 72.5×10^(9)/L and 83.21 pg/ml. When PLT ≤72.5×10^(9)/L and When(1-3)-β-D glucan ≥83.21 pg/ml, the sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of TSM were 86.67%, 90.00%, 89.66%, and 87.10% respectively. Conclusion PLT ≤72.5 in AIDS patients with gastrointestinal bleeding×10^(9)/L and(1-3)-β-D glucan ≥83.21 pg/ml, high vigilance should be considered to the possibility of TSM.

关 键 词：(1-3)-β-D葡聚糖 血小板 马尔尼菲篮状菌病 艾滋病 

分 类 号：R379.9[医药卫生—病原生物学] R512.91[医药卫生—基础医学]