检测(1,3)-β-D-葡聚糖在老年肺癌侵袭性肺部真菌感染中的临床价值

Clinical Value of Plasma (1,3)-β-D-Glucan Detection for Invasive Fungal Infections in Aged Patients with Lung Cancer

目的探讨血浆(1,3)-β-D-葡聚糖(BG)在老年肺癌侵袭性肺部真菌感染(IPFI)中的临床价值。方法老年肺癌合并感染患者65例,根据诊断分3组:侵袭性肺部真菌感染20例(A组)、混合性肺部感染(真菌+细菌)22例(B组)、细菌性肺部感染23例(C组),另设健康对照组20例(D组)。A、B、C组患者于入院第1、3天采集静脉血,A、B组患者于抗真菌治疗第3、7、10、14、17、21、24天采集静脉血,D组采集静脉血1次,检测和分析各组的BG浓度。结果 A组和B组患者中感染白假丝酵母菌26例(61.91%);IPFI感染组(A组、B组)的BG含量均显著高于非IPFI感染组和健康组(C组、D组)(P<0.01);双份血浆标本BG试验阳性在A组和B组患者中的敏感性及阴性预测值均较单份血浆标本BG试验阳性下降,但其特异性及B组患者中的阳性预测值则有所升高。与治疗前比较,A组治疗第10、14、17、21、24天血浆的BG含量均显著降低(P<0.05),B组治疗第14、17、21、24天血浆的BG含量均显著降低(P<0.01)。结论血浆BG检测对于老年肺癌IPFI患者具有早期、快速诊断和动态监测治疗效果的价值。

Objective To analyze the clinical value of the detection of plasma （1,3）-β-D-glucan （BG） for invasive fungal infection （ IPFI ） in aged patients with lung cancer .Methods Sixty-five aged lung cancer patients with infection were divided into 3 groups according to the diagnostic result ,20 cases of IPFI（group A）,22 cases of pulmonary mixed infection（fungi ＋bacteria,group B） and 23 cases of pulmonary bacterial infection （group C）.In addition,20 healthy people were enrolled in this study （ group D ） .The blood was drew from all patients 1,3 days after they were admitted to hospital,and 3,7,10,14,17,21,24 days from the patients in group A and group B after antifungal therapy , and once only from the patients in group D .The concentration of plasma BG was detected among patients in each group.Results Candida Albicans was cultured in 26 patients in group A and group B,which accounted for 61.91%. The concentration of plasma BG in group A and group B was significantly higher than that in group C and group D （ P〈0 .01 ） .In the patients of group A and group B , the sensitivity and negative predictive value of consecutive BG positive decreased ,but the specificity increased compared with those of single BG positive ,and the positive predictive value of consecutive BG positive of patients in group B increased in contrast with that of single BG positive .The concentrations of plasma BG in patients 10 ,14 ,17 ,21 and 24 days after treatment significantly reduced in contrast with those before treatment in group A（P〈0.05）.The concentrations of BG in plasma of patients 14,17,21 and 24 days after treatment significantly reduced in contrast with those before treatment in group B （P〈0.01）.Conclusion The （1,3）-β-D-glucan test is a valuable method for diagnosing IPFI at early stage rapidly as well as monitoring the efficacy dynamically in aged patients with lung cancer .