血浆1,3-β-D-葡聚糖诊断恶性血液病患者侵袭性真菌感染的临床研究

Clinical value of plasma 1,3-β-D-glucan in diagnosis of invasive fungal infections in hematologic malignancies patients

目的探讨血浆1,3-β-D葡聚糖用于诊断恶性血液病患者侵袭性真菌感染的临床价值。方法选取确诊或怀疑侵袭性真菌感染的恶性血液病患者418例及同期无真菌感染的恶性血液病患者366例。结果以≥50pg/ml为阳性诊断标准时BG结果阳性者334例,阳性率42.60%,以≥20pg/ml为阳性诊断标准时BG结果阳性者408例,阳性率52.04%,以≥20mg/ml为阳性标准时该试验的敏感性和阴性预测值均明显高于≥50pg/ml为阳性标准,两种标准之间差异有统计学意义(P<0.05);而两种标准的特异性和阳性预测值差异无统计学意义。结论通过1,3-β-D葡聚糖检测可以对恶性血液病患者侵袭性真菌感染进行早期诊断,而且医师可以根据经验以不同的阳性界值对其敏感性和特异性进行调节,即减少预防用药造成的毒性和增加的费用,又避免了侵袭性感染危及患者生命。

OBJECTIVE To explore the clinical value of plasma 1 ,3‐β‐D glucan in the diagnosis of invasive fungal infections in the hematologic malignancies patients .METHODS A total of 418 hematologic malignancies patients with confirmed or suspected invasive fungal infections were recruited as the study objects ,meanwhile ,366 hema‐tologic malignancies patients without fungal infections were also enrolled .RESULTS Totally 334 patients were tested positive for BG when the positive diagnostic criteria was set as ≥ 50 pg/ml ,with the positive rate of 42 .60% ;408 patients were tested positive for BG when the positive criteria was set as ≥20 pg/ml ,with the posi‐tive rate of 52 .04% .The sensitivity and the negative predictive value of the test were significantly higher when the positive criteria was set as ≥20 mg/ml than when it was set as ≥50 mg/ml （P＆lt;0 .05）;while there was no sig‐nificant difference in the specificity or the positive predictive value between the two criteria .CONCLUSION The detection of the plasma 1 ,3‐β‐D‐glucan can be used for the early diagnosis of invasive fungal infections in the hema‐tologic malignancies ,and the doctors can adjust the sensitivity and specificity based on different positive cutoff val‐ues ,which can not only reduce the toxicity induced by antibiotics prophylaxis and the increase of cost but also avoid the invasive infections of threatening the patients lives .