血浆β-1,3-D-葡聚糖对深部真菌感染诊断的研究

Study of β-1,3-D-glucan on the diagnosis of invasive fungal infection

目的观察血浆β-1,3-D-葡聚糖对深部真菌感染诊断的作用。方法将2005年8月～2006年6月北京友谊医院145例患者(标本182份)分为深部真菌感染组和无深部真菌感染组,分析比较两组葡聚糖水平;使用ROC曲线确定最佳临界值。结果深部真菌感染组的葡聚糖水平64.7±86.0(25.5)pg/ml明显高于对照组6.3±21.0(0.0)pg/ml(P<0.001);血浆葡聚糖用于诊断深部真菌感染的ROC曲线下面积为0.887(95%的置信区间为0.795～0.979),使用临界值13.7pg/ml诊断深部真菌感染的敏感度、特异度、阳性预测值和阴性预测值分别为88.9%、90.2%、50.0%和98.7%;Kappa值0.588(P<0.05)。结论血浆葡聚糖水平可用于诊断深部真菌感染,本研究中使用GKT-5MSet动态真菌检测试剂盒检测血浆葡聚糖水平诊断深部真菌感染的最佳临界值为13.7pg/ml,使用此临界值对深部真菌感染进行诊断在本研究中的一致性较好。

Objective To study β-1,3-D-gluean on the diagnosis of invasive fungal infection. Methods One hundrend forty five patients from Beijing Friendship Hospital were divided into two groups according to whether or not be diagnosed as invasive fungal infection. Plasma level of β-1,3-D-glucan in two groups were determined and compared. Optimal cut-off value was established with ROC curve. Results Patients diagnosed as invasive fungal infection showed a higher plasma level of BG than that of control group. （ P 〈 0. 001 ） Area under curve（AUC） was 0. 887 （95% confidence interval between 0. 795 and 0. 979） when BG level was applied to diagnose invasive fungal infection. The sensitivity, specificity, and positive and negative predictive values for BG were 88. 9% ,90.2% ,50.0% and 98.7% , respectively, with Kappa value of 0. 588. Conclusion Level of BG could be used for diagnosis of invasive fungal infection. Optimal cut-off value of plasma BG with GKT-5M Set for diagnosis of invasive fungal infection in this experiment should be 13.7 pg/ml which exhibited fine consistency.