某院ICU病房老年侵袭性假丝酵母菌感染患者与血清1,3-β-D-葡聚糖和PCT的关系

Relationships between Invasive Candida Infections and Serum 1,3-β-D-Glucan and Calcitonin Levels in Elderly Patients in ICU of a Hospital

目的探讨血清1,3-β-D-葡聚糖及降钙素原(PCT)水平在ICU侵袭性假丝酵母菌感染老年患者中的诊断价值。方法选取47例假丝酵母菌感染老年患者(感染组)及50例老年健康体检者(对照组),感染组和对照组患者分别于入住ICU、体检时检测1,3-β-D-葡聚糖及PCT水平。结果感染组血清1,3-β-D-葡聚糖及PCT水平均显著高于对照组(P<0.05)。感染组血清1,3-β-D-葡聚糖诊断受试者工作特征曲线(ROC)曲线下面积(AUC)为0.921;针对老年患者,1,3-β-D-葡聚糖最佳cut-off值为24.2ng·L-1,诊断敏感度为93.9%,特异性为81.6%;感染组PCT诊断AUC为0.832,针对老年患者,PCT最佳cut-off值为0.55ng·L-1,诊断敏感度为82.7%,特异性为80.9%;1,3-β-D-葡聚糖诊断效能优于PCT(Z=2.723,P=0.006,P<0.05)。感染组1,3-β-D-葡聚糖阳性检出率(89.36%)显著高于PCT阳性检出率(44.68%)(χ2=16.000,P<0.05)。结论血清1,3-β-D-葡聚糖检测对老年患者假丝酵母菌感染诊断具有高度灵敏度与特异性,诊断效能高;PCT检测诊断效能低于1,3-β-D-葡聚糖,但也可辅助临床早期诊断侵袭性假丝酵母菌感染。

Objective To investigate the values of serum 1,3-β-D-glucan and calcitonin（PCT）levels in the diagnosis of invasive Candida infections in elderly patients in ICU.Methods Serum1,3-β-D-glucan and PCT levels were determined in 47elderly patients with invasive Candida infections（infection group）and 50healthy subjects（control group）at ICU admission and at physical examination,respectively.Results Serum 1,3-β-D-glucan and PCT levels in infection group were significantly higher than those in control group（P〈0.05）.The receiver operating characteristic area under the curve（ROC-AUC）was 0.921for 1,3-β-D-glucan with an optimal cut-off value of24.2ng·L^-1,a sensitivity of 93.9% and a specificity of 81.6%in elderly patients.The ROCAUC was 0.832for PCT with an optimal cut-off value of 0.55ng·L^-1,a sensitivity of 82.7%and a specificity of 80.9%in elderly patients.The diagnostic efficiency of 1,3-β-D-glucan was higher than that of PCT for invasive Candida infections（Z=2.723,P=0.006,P〈0.05）.In addition,the positive detection rate of 1,3-β-D-glucan（89.36%）was higher than that of PCT（44.68%）（χ2=16.000,P〈0.05）.Conclusion Serum 1,3-β-D-glucan detection has higher sensitivity,specificity and diagnostic efficiency than PCT detection for the diagnosis of invasive Candida infections in elderly patients.However,serum PCT detection can be used as an assistant method for the diagnosis of invasive Candida infections.