血浆中(1-3)-β-D葡聚糖检测和真菌培养在诊断深部真菌感染中的临床意义

Clinical Significance of Plasma (1,3) β-D-glucan Detection and Fungal Culture on the Diagnosis of Deep Fungal Infection

目的探讨血浆中(1-3)-β-D葡聚糖和真菌培养在诊断深部真菌感染中的临床价值。方法对江阴市人民医院2009年6月—2010年5月长期使用免疫抑制剂、皮质类固醇激素和(或)广谱抗生素、且有感染体征的216例患者,在其发热当天抽静脉血做(1-3)-β-D葡聚糖检测,同时留取血液、呼吸道、泌尿道和肠道标本做真菌培养。通过回顾性调查,以临床用药及患者症状缓解与否作为临床诊断标准,并比较两者的差异。结果 216例患者中使用抗真菌药物且症状缓解64例,使用抗真菌药物症状未缓解和未使用抗真菌药物并症状缓解152例。在216例患者中,(1-3)-β-D葡聚糖含量检测阳性62例,阴性154例;真菌培养阳性118侧,阴性98例。(1-3)-β-D葡聚糖含量检测与真菌培养结果阳性率比较,差异有统计学意义(χ2=11.529,P<0.01);(1-3)-β-D葡聚糖含量检测与临床诊断阳性率比较,差异无统计学意义(χ2=0.0105,P>0.05);真菌培养与临床诊断阳性率比较,差异有统计学意义(χ2=11.215,P<0.01)。结论血浆中(1-3)-β-D葡聚糖检测在诊断深部真菌感染方面有较高的临床价值且明显优于真菌培养。

[Objective] To study the clinical value of plasma （1,3） β-D-glucan and fungal culture on the diagnosis of deep fungal infection.[Methods]216 patients who were treated by immunosuppressive agents, corticosteroids and （or） broad spectrum antibiotics for a long time, and had infections sign were collected in Jiangyin People＇s Hospital from June 2009 to May 2010, patients were phlebotomized for the detection （1,3） β-D-glucan when they had a fever, and the fungal culture was conducted in the samples of blood, respiratory tract, urinary tract and intestine. With retrospective study, the clinical medication and whether the symptoms of patients had been alleviated were regarded as the clinical diagnostic standards, and the difference between two means was compared.[Results]Among 216 patients, the symptoms of 64 patients were alleviated after treatment by antifungal agents, and 152 patients did not get remission after treatment by antifungal agents or got remission without antifungal agents. 62 patients were positive for （1,3） β-D-glucan detection and 154 patients were negative. 118 cases were positive in fungal culture, and 98 cases were negative. There was significant difference in the positive rate between the （1,3） β-D-glucan detection and the fungal culture （χ^2=11.529,P〈0.01）. There was no significant difference in the positive rate between the （1,3） β-D-glucan detection and clinical diagnosis （χ^2=0.0105,P〈0.05）. There was significant difference in the positive rate between the fungal culture and the clinical diagnosis （χ^2=11.215,P〈0.01）.[Conclusion]The plasma （1,3） β-D-glucan detection has a high clinical value on the diagnosis of deep fungal infection, and is better than the fungal culture significantly.