侵袭性真菌感染患者1,3-β-D葡聚糖检测的临床价值

The clinical value of measuring the 1,3-β-D-glucan among the patients with invasive fungal infections

目的评价1,3-β-D葡聚糖(BG)检测对侵袭性真菌感染(IFI)早期诊断和疗效监测价值。方法应用MB-80微生物动态快速检测系统及GKT-5M set动态真菌检测试剂盒定量检测血浆中BG的含量。结果以50 pg/mL为阳性界值,BG检测的敏感性为72.5%,特异性91.4%,阳性预测值90.6%,阴性预测值74.4%。以20 pg/mL为阳性界值,敏感性为87.5%,特异性88.6%,阳性预测值89.7%,阴性预测值86.1%。连续监测时BG可早于真菌培养方法1～10 d预测真菌感染。在BG阳性患者中,对20例患者进行抗真菌治疗,19例有效,1例无效死亡。抗真菌治疗前BG水平呈缓慢上升趋势,保持在较高水平,抗真菌治疗有效患者的BG含量呈下降趋势,无效死亡患者呈上升趋势。结论血浆BG浓度对血液病和恶性肿瘤患者IFI早期诊断和疗效评价有重要价值。

Objective To estimate the value of measuring the 1,3-β-D-glucan（BG） to early diagnosis and monitor the curative effect among the patients with invasive fungal infection（IFI）. Methods 309 blood samples were obtained from 112 patients with leukemia and malignant tumour. The serum BG concentration of patients with IFI were determinated dynamically with Microbiology Kinetic Rapid Reader MB-80. Results The BG showed high sensitivity （72.5% and 87.5%） and specificity（91.4% and 88.6%） when the threshold value were assigned to 50pg/ml and 20pg/ml. With continuous monitoring the BG, it could predict the IFI earlier that the method of fungus culture about 1-10 days. Among 20 patients of positive BG given antifungal therapy, 19 cases had good response, only 1 case died. Declining BG concentrations have been observed in patients who responded to antifungal therapy,however, rising concentrations with fatal outcome. Conclusion Measurement the BG may be useful to diagnosis the IFI early and evaluate the curative effect among the patients with leukemia and malignant tumour.