血浆(1,3)-β-D葡聚糖检测对器官移植患者侵袭性真菌感染诊断价值

The diagnostic value of plasma 1,3-β-D glucan to invasive fungal infection in organ transplant recipients

目的探讨血浆(1,3)-β-D葡聚糖(BG)检测(G试验)在诊断器官移植术后合并侵袭性真菌感染(IFI)的诊断价值。方法回顾性分析2011年1月～2012年12月130例在本院肝、肾移植中心住院疑似IFI的患者的血浆标本,进行G实验检测。其中64例最终确诊或临床诊断为IFI患者,设为IFI组,余66例为非IFI组。应用MB-80微生物动态快速检测系统和GKT-5M Set动态真菌检测试剂盒,血浆BG浓度≥10 pg/mL判定G试验阳性。采用四格表计算G试验诊断IFI的敏感度、特异度、阳性预测值和阴性预测值。对G试验结果进行受试者特征工作曲线(ROC曲线)分析,并计算曲线下面积。结果 130例患者中,IFI组中G试验阳性57/64,阳性率89.1%;阴性7例,假阴性率10.9%。非IFI组G试验阳性15/66,假阳性率22.7%。G试验阳性诊断IFI的敏感度、特异度、阳性预值和阴性预测值分别为89.1%,77.3%,79.2%和87.9%。根据G试验结果绘制ROC曲线,曲线下面积为0.875(95%CI:0.813～0.937)。结论 G试验对器官移植患者IFI具有中等诊断价值。适当提高诊断界值及重复检测可较大程度地消除假阳性。

Objective To evaluate the diagnostic value of plasma 1,3-β-D glucan （BG） assay （G test） to invasive fungal infection （IFI） in organ transplant recipients. Methods By retrospectively accessing the clinical data of pediatric inpatients who underwent G test. The patients being recruited from January 2011 to December 2012 were split into two groups： group IFI comprised 64 pa- tients with proven and probable IFI. Group control comprised 66 patients without fungal infection. G test was performed by the GKT- 5 M Set Kinetic Fungus Detection Kit. It was judged as positive when the plasma BG level ≥ 10 pg/mL. 2 by 2 table was used to cal- culate the G test for the diagnosis of IFI sensitivity, specificity, positive predictive value and negative predictive values. Receiver operating curve （ROC） of G test was analyzed, and the area under the curve was calculated. Results In IFI group G test was positive in 57 cases, the positive rate was 89.06%. 15 cases of non-IFI group were positive, false positive rate was 22.7%. The G test sensitivity, specificity , positive and negative predictive values were89.1% ,77.3% ,79.2% and 87.9% respectively. According to ROC analysis, the AUC was 0. 875 （95 % CI ： 0.813 - 0. 937）. Conclusions G test has good diagnostic value of IFI in organ transplant patients . Appropriately higher cutoffs or continuous monitoring may significantly control false positive rate of the test.