血浆(1,3)-β-D葡聚糖水平对艾滋病患者合并肺孢子菌肺炎诊断及预后的临床价值  

Clinical value of (1,3)-β-D-glucan levels in diagnosis and prognosis of AIDS patients complicated with Pneumocystis pneumonia

作　　者：兰慧慧 陈涛[2] 蒋忠胜[2] 李敏基[2] 覃锦玉 莫胜林[2] 蒙达礼[2] 唐贵 LAN Huihui;CHEN Tao;JIANG Zhongsheng;LI Minji;QIN Jinyu;MO Shenglin;MENG Dali;TANG Gui(Department of Respiratory Medicine,Chest Hospital of Guangxi Zhuang Autonomous Region,Liuzhou 545005,China;Department of Infectious Diseases,Liuzhou General Hospital,Liuzhou 545004,China)

机构地区：[1]广西壮族自治区胸科医院呼吸内科,柳州545005 [2]广西柳州市人民医院感染病科,柳州545004

出　　处：《中国真菌学杂志》2022年第6期476-481,共6页Chinese Journal of Mycology

基　　金：“十三五”国家科技重大专项课题(2018ZX10302104-001-008)。

摘　　要：目的 探讨血浆(1,3)-β-D葡聚糖水平对艾滋病(AIDS)患者合并肺孢子菌肺炎(Pneumocystis pneumonia,PCP)的临床诊断及预后价值。方法 回顾性分析柳州市人民医院2012年1月—2021年1月收治的110例AIDS患者,观察组55例为临床诊断PCP者,对照组55例为无机会性感染者。另观察组患者又分为好转组(31例)和死亡组(24例)。分别比较观察组与对照组、好转组(基线)与死亡组(基线)、好转组(基线)与治疗后(4周)、死亡组(基线)与治疗后(死亡时)间血浆(1,3)-β-D葡聚糖水平,通过ROC曲线评估(1,3)-β-D葡聚糖对AIDS患者合并PCP临床诊断及预后的价值。结果 (1,3)-β-D葡聚糖水平对照组低于观察组[9.00(4.00,56.95)pg/mL vs.182.50(100.60,355.00)pg/mL],好转组(基线)低于死亡组(基线)[115.20(92.40,198.20)pg/mL vs.360.70(253.50,523.20)pg/mL],好转组(基线)高于治疗后(4周)[115.20(92.40,198.20)pg/mL vs.34.39(10.00,81.45)pg/mL],死亡组(基线)低于治疗后(死亡时)[360.70(253.50,523.20)pg/mL vs.550.90(369.48,631.30)pg/mL],(1,3)-β-D葡聚糖阳性率对照组低于观察组[21.82%vs.92.73%],好转组(基线)高于治疗后(4周)[87.10%vs.25.81%],差异均有统计学意义(P<0.05)。(1,3)-β-D葡聚糖阳性率在好转组(基线)与死亡组(基线)、死亡组(基线)与治疗后(死亡时)间差异无统计学意义(P>0.05)。当(1,3)-β-D葡聚糖≥77.65 pg/mL时,用于诊断PCP的敏感度、特异度、阳性预测值、阴性预测值分别为89.09%、87.27%、87.50%和88.89%。当(1,3)-β-D葡聚糖≥247.95 pg/mL时,用于预测PCP患者预后的敏感度、特异度、阳性预测值、阴性预测值分别为79.17%、93.55%、90.48%和85.29%。结论 血浆(1,3)-β-D葡聚糖水平可以作为PCP的一个早期诊断指标,以及用来预测患者的临床预后。Objective To evaluate the clinical value of level of the plasma(1,3)-β-D-glucan in diagnosis and prognosis of the acquired immune deficiency syndrome(AIDS) patients complicated with Pneumocystis pneumonia(PCP).Methods A retrospective analysis of 110 AIDS patients who were hospitalized to Liuzhou People’s Hospital from January 2012 to January 2021,55 patients who were clinically diagnosed with PCP were assigned as the observationg,while 55 patients with non-opportunistic infections were set as the control group.The observation group was further divided into improvement group(31 cases) and death group(24 cases).The plasma levels of(1,3)-β-D-glucan were compared.The clinical diagnosis and prognosis values of(1,3)-β-D-glucan for PCP AIDS patients with PCP were evaluated by ROC curve.Results(1,3)-β-D-glucan level in control group was lower than that in observation group [9.00(4.00,56.95)pg/mL vs.182.50(100.60,355.00)pg/m L],improvement group(baseline) was lower than death group(baseline)[115.20(92.40,198.20)pg/m L vs.360.70(253.50,523.20)pg/m L],improvement group(baseline) was higher than post-treatment(4 weeks) group [115.20(92.40,198.20)pg/m L vs.34.39(10.00,81.45)pg/m L],death group(baseline)was lower than post-treatment(at death) group [360.70(253.50,523.20)pg/m L vs.550.90(369.48,631.30)pg/m L].The positive rate of(1,3)-β-D-glucan in control group was lower than that in observation group [21.82%% vs.92.73%],the positive rate of(1,3)-β-D-glucan in improvement group(baseline) was higher than that in post-treatment(4 weeks) group[87.10% vs.25.81%].When(1,3)-β-D-glucan≥77.65pg/m Lthe,sensitivity、specificity、positive predictive value and negative value for diagnosis of PCP were 89.09%、87.27%、87.50% and 88.89% respectively.When(1,3)-β-D-glucan≥247.95 pg/m L,the sensitivity、specificity、positive predictive value and negative value for predicting the prognosis of PCP were 79.17%、93.55%、90.48% and 85.29% respectively.Conclusion Plasma(1,3)-β-D-glucan levels can be used as an early diagnostic

关 键 词：(1 3)-β-D葡聚糖 肺孢子菌肺炎 艾滋病 诊断 预后 

分 类 号：R519.8[医药卫生—内科学] R563.1[医药卫生—临床医学]