真菌血清学G试验、GM试验、真菌涂片培养在ICU患者合并侵袭性真菌感染中的临床诊断价值  

Clinical Diagnostic Value Research of Fungal Serological G,GM Test,and Fungal Smear Culture of Patients with Invasive Fungal Infections in ICU

作　　者：刘瑜[1] LIU Yu(Tianshui City the First People's Hospital,Tianshui,Gansu 741000)

机构地区：[1]天水市第一人民医院,甘肃天水741000

出　　处：《智慧健康》2024年第24期19-21,46,共4页Smart Healthcare

摘　　要：目的分析真菌血清学G试验、GM试验、真菌涂片培养在ICU患者合并侵袭性真菌病感染(invasive fungal infections,IFI)中的临床诊断价值。方法选取2021年3月—2023年5月本院收治的ICU疑似真菌感染患者202例为研究对象,根据临床诊断结果分为IFI组(n=155例)及非IFI组(n=47例),所有患者均行G试验、GM试验及真菌涂片培养。分别比较两组ICU患者的G试验、GM试验及真菌涂片培养的单独试验结果,G试验、GM试验联合试验结果以及G试验、GM试验、真菌涂片培养试验联合试验结果;对比分析三种检测试验方法的临床诊断价值。结果IFI组G试验阳性率为88.9%,GM试验阳性率为66.7%,涂片培养阳性率为80.5%,G试验+GM试验阳性率为95.8%,三者联合检测阳性率为97.2%;非IFI组G试验阳性率为17.7%,GM试验阳性率为8.5%,涂片培养阳性率为19.2%,G试验+GM试验阳性率为14.6%,三者联合检测阳性率为10%。此次研究对202例ICU患者进行痰涂片培养,其中检出数量最多的前三位为白假丝酵母菌(47%)、光滑假丝酵母菌(15.2%)及近平滑假丝酵母菌(12.1%),G试验、GM试验及痰涂片培养单独试验结果的阴性预测值、阳性预测值、特异度及敏感度差异无统计学意义(P>0.05);G试验+GM试验联合的敏感度高于单独G试验、GM试验及痰涂片培养(P<0.05),但阴性预测值与单独G试验差异无统计学意义(P>0.05);三者联合试验的敏感度及阴性预测值均高于单独试验结果(P<0.05)。结论G试验、GM试验和真菌涂片培养三者联合检测可以提高ICU患者IFI早期诊断的敏感性,指导临床医生早期用药治疗合并侵袭性真菌病,从而改善患者的预后。Objective To review and analyze clinical diagnostic value of fungal serological G,GM test and fungal smear culture of patients with invasive fungal infections in ICU.Methods The paper chose 202 suspected fungal infection patients in our hospital from March 2021 to May 2023,and divided into IFI group(n=155)and non IFI group(n=47)based on clinical diagnosis.All patients were treated with G test,GM test and fungal smear culture.Individual results of G test,GM test and fungal smear culture;G and GM test combined test;G and GM test and fungal smear culture test were compared between two groups.Clinical diagnostic value of three testing methods was compared and analyzed.Results Positive rate of G test,GM test,smear culture,G test and GM test in IFI group was 88.9%,66.7%,80.5%,95.8%and 97.2%respectively;that of G test in non IFI group was 17.7%,that of GM test was 8.5%,that of smear culture was 19.2%,that of G test+GM test was 14.6%,and that of combined detection of three was 10%.The study carried out sputum smear culture for 202 patients in ICU,and top three strains detected were candida albicans(47%),candida glabrata(15.2%),and candida parapsilosis(12.1%).There was no statistically significant difference in negative predictive value,positive predictive value,specificity and sensitivity of results of G test,GM test and sputum smear culture individually,(P>0.05).Sensitivity of combination of G test and GM test was higher than G test,GM test and sputum smear culture individually,(P<0.05).There was no significant difference in negative predictive value from G test only,(P>0.05).Sensitivity and negative predictive value of combined test of the three was higher than individual test results,(P<0.05).Conclusion Combined detection of G-test,GM test and fungal smear culture can improve sensitivity of early diagnosis of patients in ICU,guide clinical doctors in early medication treatment of invasive fungal diseases,and improve prognosis of patients.

关 键 词：G试验 GM试验 真菌涂片培养 ICU重症患者 侵袭性真菌感染 敏感度 早期诊断 

分 类 号：R519[医药卫生—内科学]