自然咳出痰标本真菌半定量培养的临床准确性探讨

Studies on clinical accuracy of fungus cultivated with half fixed amount in sputum to cough out naturally

目的把握自然咳出痰液真菌半定量培养的临床准确性。方法建立相对准确适用的呼吸道分泌物真菌半定量培养12级法,对不同年龄段无呼吸道炎症患者咽拭子和临床呼吸道炎症患者自然咳出的痰液标本进行真菌半定量培养;统计分析出院时确诊为呼吸道真菌感染患者的病历资料,列出四格表,计算其临床准确性。结果无呼吸道炎症人群口咽部真菌半定量培养的阳性概率为0.090(56/622),其中≥50岁组为0.175(41/234);均为念珠菌;数量均为少量。出院时确诊呼吸道真菌感染患者的培阳率为0.972(700/720),其中≥50岁组为0.976(638/654)。其临床准确性指标:灵敏度、特异度、阳性预测值、阴性预测值、准确度、尤登指数、阳性似然比、阴性似然比分别为0.972、0.910、0.926、0.996、0.943、0.882、10.8、0.031,≥50岁组分别为0.976、0.825、0.940、0.923、0.936、0.801、5.577、0.029;总体与≥50岁组比较,其灵敏度χ2为0.149,P>0.5;特异度χ2为10.314,P<0.01。结论痰液真菌半定量培养的灵敏度高而特异度略低,若同时进行特异度高的其它检验(譬如直接涂片检查等),将更有价值;若从自然咳出的痰液中检出非念球菌真菌,则有感染菌的可能;若数量大于少量,则意义更大;≥50岁组存在较高的真菌感染风险性;鉴于真菌感染患者中≥50岁组高达0.91(654/720),相关指标以≥50岁组者更具临床实用价值。

Objective Know chnical aceracy of fungus cultivated with half fixed amount in sputum ＂to cough out naturally＂. Methods Establish the 12 ranks method of fundus cultivated with half fixed amount in respiratory system secretion. Investigate the positive probability and quantity on fungus carried at throat of the crowd whose respiratory system is not inflamed. Fungus cultivated with half fixed amoung in sputum＂to cough out naturally＂ of the patients whose respiratory system is inflamed. Analyzing the medical history of the patients diagnosed fungus infection at time of farewell hospital. List four space form. Compute its clinical accuracy target. Results For crowd whose respiratory system is not inflamed, the positive probability of fungus cultivated is 0.090 （56/622）, insicde ≥ 50 age set is 0.175（41/234） ;These funguses are all eandida and ＂little amount＂. The cultivated ＋ rate of the patients diagnosed fundus infection at time of farewell hospital is 0.972 （ 700/720 ）, inside ≥50 age set is O. 976 （ 638/654）. Its clinical accuracy target ： sensitivity, specificity, positive PV, negative PV, accuracy, youden＇ s index, ＋ likelihood ratio, - likelihood ratio is separately 0.972, 0. 910, 0. 926,0.996, 0.943,0.882,10.8,0.031, inside ≥ 50 age set is separately 0.976,0.825,0.940,0.923,0.936,0.801,5.577,0.029. Comparing all case with ≥ 50 age, sensitivity ;χ^2 = 0. 149, P 〉 0.5 ; specificity χ^2= 10. 314, P 〈 0.01. Comelusiem Sensitivity high but specificity slightly low of fungus cultivated with half fixed amount in sputum. If proceeding at same time with other examination of specificity high （such as fundns smeared directly）, Value Will be Larger. If fungus cultivated is not candida from sputum ＂to cough out naturally＂, infection cause is passible. If its quantity larger than ＂little mount＂, diagnosis value is larger, Risk that crowd of ≥ 50 age infected with fungus is higher. Considering that ≥ 50 age set of fungous infection case exceed 0.91 （654/720）, the target of ≥ 50 age set has more practical value.