支气管肺泡灌洗液葡聚糖检测对早期诊断侵袭性肺真菌感染的价值

Test value of( 1,3)- β- D- glucan in BALF in the early diagnosis of invasive pulmonary fungal infections

目的探讨支气管肺泡灌洗液(BALF)中的(1,3)-β-D葡聚糖(BG)检测对早期诊断侵袭性肺真菌感染(IPFI)的价值。方法 (1)选择2011年6月至2013年12月六安市人民医院收治的172例患者,其中确诊IPFI组、普通感染组和无肺部感染组各32例,共96例,此外入院时有真菌感染的高危因素但早期未确诊IPFI者76例作进一步研究,每日连续真菌检测直至明确是否为IPFI,进而分诊断组、排除组。全部对象均予支气管肺泡灌洗,留取BALF及血浆进行G试验(BG抗原检测),对数据采用独立样本秩和检验来检验并绘制受试者工作ROC曲线,确定两种标本检测方法诊断IPFI的最佳临界值。结果 (1)BALF G试验水平:IPFI组明显高于单纯肺炎组和非感染组。(2)76例未确诊病例在随后的5 d检查中7例确诊IPFI,22例临床诊断,29例剔除,18例排除真菌感染。(3)诊断组BALF、血浆BG水平均显著高于排除组,BALF BG浓度为149.5 ng·L-1时对应的约登指数值最大,为0.87,血浆BG浓度为81 ng·L-1时对应的约登指数值最大,为0.81。(4)诊断组BALF BG峰值浓度出现时间早于血浆,同时诊断的特异性高于血浆。结论 (1)BALF中BG的含量较血浆中升高更明显,且BALF G试验在区分单纯肺炎和IPFI方面更具有参考价值。(2)BALF G试验特异度、敏感度均明显高于血浆G试验,且峰值出现早于血浆,具有更早、更准确、更高的临床诊断价值。(3)BALF G试验的最佳诊断临界值是149.5 ng·L-1,其诊断IPFI的特异性和敏感性均较高。

Objective To explore the test value of （1,3）-β-D-glucan in BALF in the early diagnosis of invasive pulmonary fungal in-fections（IPFI）.Methods We selected 172 patients admitted to the Lu’an Hospital from June 2011 to December 2013,32 patients of which enrolled in the confirmed IPFI group,32 patients in pneumonia infection group,and 32 patients in non-infection group.Another 76 patients who had high risk factors of fungi infection but no evidence of confirmed IPFI when they were charged in hospital were stud-ied further.They were detected every day to determine whether they had fungal infection before assigned into either confirmed group or non-infection group.All patients underwent BAL and took G test of BALF and plasma.The data were analyzed statistically by independ-ent samples rank sum test and the receiver operating characteristics （ ROC） curve was established to derive the best threshold of the 2 G tests.Results As for G test of BALF,the mean of IPFI group was significantly higher than pneumonia infection group and non-infec-tion group.Of the 76 cases,7 cases were confirmed as IPFI in the subsequent 5-day examination,22 cases clinically diagnosed,29 cases excluded and 18 cases enrolled in non-infection group.ROC area under the curve of G test of BALF for the diagnosis of IPFI was 0.87, and the best threshold was 149.5 ng· L^-1 ,while those for G test of plasma was 0.81 and 81 ng· L^-1 .The maximum concentration of （1,3）-β-D-glucan of BALF came earlier than the plasma and the specificity was higher.Conclusions BG in BALF is significantly higher than that in plasma and G test of BALF may be more advantageous over plasma in distinguishing between simple pneumonia and IPFI.The sensitivity and specificity of G test of BALF are higher than those of plasma,which has earlier peak value and more accurate and higher clinical value.The best threshold of G test of BALF for the diagnosis of IPFI is 149.5 ng· L^-1 ,whose sensitivity and speci-ficity in diagnosis of IPFI is higher.