血浆1,3-β-D葡聚糖检测对慢性阻塞性肺疾病并发肺部真菌感染的研究

Detection of plasma(1,3)-β-D-glucan antigens in diagnosis of invasive pulmonary fungal infections in patients with chronic obstructive pulmonary disease

目的评价1,3-β-D葡聚糖抗原检测(G试验)对慢性阻塞性肺疾病(COPD)并发侵袭性肺部真菌感染(IPFI)的诊断、疗效预测价值。方法检测179例有并发IPFI高危因素的COPD患者的血浆G值,计算G试验的灵敏度、特异性、阳性预测值、阴性预测值及准确性;对G试验阳性的患者进行抢先的抗真菌治疗,动态监测G值的变化。结果 G试验对COPD患者并发IPFI的灵敏度为81.7%,特异性为89.7%,阳性预测值为89.1%,阴性预测值为82.5%,准确性为85.6%;70例G试验阳性患者40例完成抗真菌的抢先治疗,37例治疗有效,3例治疗无效,治疗有效率92.5%;抗真菌治疗前G值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G含量呈下降趋势,无效患者中G值无明显变化。结论 G试验灵敏度、特异度较高,高危患者结合临床表现,G试验检测阳性应立即抗真菌治疗,动态检测G值变化可有效判断治疗效果。

OBJECTIVE To evaluate the value of plasma（1,3）-β-D-glucan antigens（G test） in the diagnosis and prediction of invasive pulmonary fungal infection（IPFI） in patients with chronic obstructive pulmonary disease（COPD）.METHODS The plasma（1,3）-β-D-glucan antigens（G test） levels in 179 high-risk patients were measured.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of G test were calculated.The patients were managed with proactive antifungal therapy if G test was positive.The change of G values were analyzed.RESULTS The results showed that the sensitivity,specificity,positive predictive values,negative predictive values and accuracy of G tests for IPFI in patients with COPD were 81.7%,89.7%,89.1%,82.5% and 85.6%,respectively.Of the 70 G test positive patients,40 were managed by proactive antifungal therapy,good response was achieved in 37 patients.And 3 patients were ineffective due to treatment failure.The effective rate was 92.5%.G concentration was decreased for patients who responded to antifungal therapy effectively,but remained consistent for ineffective group.CONCLUSION The G test is sensitive and specific.The high-risk patients with positive G test result should begin the antifungal therapy immediately.The change of G values can be used as a reliable index to predict the antifungal effect.