(1,3)-β-D-葡聚糖在诊断深部真菌感染中的意义

Study of 1,3-beta-D-glucan on Diagnosis of Invasive Fungal Infections

探讨(1,3)-β-D-葡聚糖(BG)检测对于诊断深部真菌感染的临床意义。收集2009年同时进行(1,3)-β-D-葡聚糖检测和真菌培养的住院患者的临床资料。分析不同科室送检真菌抗原情况,重症医学科的(1,3)-β-D-葡聚糖检测阳性者真菌菌种分布情况以及(1,3)-β-D-葡聚糖检测假阳性情况。同时送检(1,3)-β-D-葡聚糖和真菌培养共275例,重症医学科送检最多,共178例:重症医学科(1,3)-β-D-葡聚糖检测阳性36例(阳性率20.22%);重症医学科(1,3)-β-D-葡聚糖检测阳性同时真菌培养阳性者25例,其中白假丝酵母菌10例,热带假丝酵母菌7例,光滑假丝酵母菌4例,阿萨希毛孢子菌2例,克柔假丝酵母菌1例,烟曲霉1例。11例(1,3)-β-D-葡聚糖假阳性,9例存在细菌菌血症。重症医学科等科室应加强真菌感染监测。深部真菌感染中,假丝酵母菌属感染最多见。细菌菌血症可能造成(1,3)-β-D-葡聚糖检测假阳性。

Significance of 1,3-beta-D-glucan（1,3bDg） detection on diagnosis of invasive fungal infection（IFI） was investigated by analyzing clinical data collected from hospitalized patients and 1,3bDg detection and fungal culture simultaneously in 2009.Fungal antigen submission rate in different departments,fungal strain distribution as well as false positive case of 1,3bDg in intensive medicine department（IMD） were analyzed.The results showed that of all delivered for detection 275 cases with simultaneous detection of 1,3bDg and fungal culture,delivered from IMD was the most,altogether 178 cases.1,3bDg positive in IMD was 36（positive rate at 20.22%）;25 cases of 1,3bDg positive with simultaneous positive fungal culture,including Candida albicans 10 cases,C.tropicalis 7 cases,C.glabrata 4 cases,Trichosporon asahii 2 cases,C.krusei 1 cases,Aspergillus fumigatus 1 case.There were 11 cases of 1,3bDg false-positive,with 9 cases existing bacteremia.Therefore,IMD and other departments should strengthen the monitoring of fungal infection.The commonest types of IFI were infection by the genus of Candida.Bacteremia might result in false positivity in 1,3bDg determination.