血浆(1,3)-β-D-葡聚糖检测对呼吸机相关性肺部真菌感染诊断的临床价值研究

Clinical Value of Plasma(1,3)-β-D-Glucan Detection in Ventilator-Associated Pulmonary Fungal Infection Diagnosis

目的研究血浆(1,3)-β-D-葡聚糖检测对呼吸机相关性肺部真菌感染诊断的临床价值。方法选择ICU进行有创机械通气48h以上,临床确诊均为肺部真菌感染的34例患者作为试验组,以33例无真菌感染的健康献血者作为对照组。对两组患者抽取静脉血做(1,3)-β-D-葡聚糖检测(G试验),将试验结果与病原学诊断结果相比较,计算G试验的敏感度、特异性、阳性预测值、阴性预测值及准确性。结果试验组患者血浆(1,3)-β-D-葡聚糖定量检测有32例阳性,血浆(1,3)-β-D葡聚糖含量为96.10±12.31pg/ml;对照组患者血浆(1,3)-β-D-葡聚糖定量检测有3例阳性,血浆(1,3)-β-D-葡聚糖含量为4.30±1.77pg/ml。两组比较差异有统计学意义(P<0.05)。血浆(1,3)-β-D-葡聚糖检测的敏感度与特异性为94.11%、90.90%;血浆(1,3)-β-D-葡聚糖检测的阳性预测值与阴性预测值为91.43%、93.75%。结论血浆(1,3)-β-D-葡聚糖检测诊断呼吸机相关性肺部真菌感染具有快速、可靠等优点,有较高的敏感度、特异性和准确性。

Objective To study clinical value of plasma （ 1,3 ） - β - D - glucan detection in ventilator - associated pulmonary fun- gal infection diagnosis. Methods Thirty four patients diagnosed as pulmonary fungal infection were selected as a test group. All patients in the test group have experienced over 48 hour＇s invasive mechanical ventilation in ICU. Another 33 healthy people with no fungal infec- tions were selected as a control group. （ 1,3 ） - β - D - glucan detection （ G test） was conducted in both groups using venous blood as the test samples. Test results were compared with the results of etiological diagnosis to assess the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of G test. Results Thirty two positive cases were found in the test group through quantita- tive detection of （ 1,3） - β - D - glucan in the plasma. And, the average content of （ 1,3） - β - D - glucan in the plasma was 96.10 ± 12.31pg/ml. While in the control group, just 3 positive cases were detected, with an average content of （ 1,3） - β - D - glucan in the plasma of 4.30 ± 1.77pg/ml. Statistically significant was observed between the two groups （ P 〈 0. 05 ）. The sensitivity, specificity, pos- itive and negative predictive value of plasma （ 1,3） - β - D - glucan detection was 94.11% , 90.90% , 91.43% and 93.75% , respec- tively. Conclusion The method of plasma （ 1,3 ） - β - D - glucan detection in ventilator - associated pulmonary fungal infection diagno- sis was fast and reliable, and has a higher sensitivity, specificity and accuracy.