血浆1,3-β-D葡聚糖检测对重症监护病房内侵袭性念珠菌感染的诊断价值

Diagnostic Value of 1,3-beta-D Glucan on Invasive Candidiasis in Intensive Care Unit Patients

目的:评价血浆1,3-β-D葡聚糖检测对重症监护病房内侵袭性念珠菌感染的早期诊断价值。方法:将我院2007年1月至2009年12月念珠菌评分(CS)≥2.0的108患者分为多部位定植(MC)组、侵袭性念珠菌感染(IC)组和非定植非感染(NCNI)组,分析比较三组CS评分、1,3-β-D葡聚糖水平;使用ROC曲线确定最佳检验临界值。结果:IC组与MC组及NCNI组CS评分均有统计学差异(P<0.05),IC组CS评分高于MC组及NCNI组:而MC组与NCNI组间无统计学差异(P>0.05)。6 h内1,3-β-D葡聚糖检测,三组组间无统计学差异(P>0.05):24 h和48 h检测,IC组与MC组及NCNI组之间均有统计学差异(P<0.05);MC组与NCNI组间无统计学差异(P>0.05)。1,3-β-D葡聚糖检测侵袭性念珠菌感染的ROC曲线下面积为24 h 0.952、48 h 0.961,最佳临界值分别为21.8 pg/mL和20.6 pg/mL。结论:血浆1,3-β-D葡聚糖检测可用于侵袭性念珠菌感染高危患者的筛查,具有早期辅助诊断、指导合理治疗干预的价值。

Objective：To evaluate the diagnostic value of 1,3-beta-D glucan for invasive candidiasis in intensive care unit （ICU） .Methods ： 108 cases were divided into three groups-invasion colonization （ IC ）, multifoeal colonization （MC） and neither colonization nor infected （NCNI）.（candida score）CS and 1,3-heta-D gluean were compared among the groups. Optimal cut-off value was established with ROC curve.Results：There was significant difference of CS between IC group and other groups （P〈0.05）, but there was no significant difference between MC and NCNI group （P〉0.05）. There was significant difference of 1,3-beta-D glucan between IC group and other groups in the time of 24 hour and 48 hour （P〈0.05）, but there was no significant difference between MC and NCNI group （P〉0.05）. The AUROC of 1,3-beta-D glucan in the time of 24 hour and 48 hour were 0.952 and 0.961. The cut-off value of 1,3- beta-D glucan was 21.8 pg/mL and 20.6 pg/mL. Conclusion. Circulating 1,3-beta-D glucan detection is accurate to a certain extent in the diagnosis of IC. It is a useful adjunct means for IC screening in ICU patients.