G试验对COPD合并侵袭性肺部真菌感染的诊断性能评价

The performance evaluation of G test on patients with invasive pulmonary fungal infections complicated with chronic obstructive pulmonary disease

目的评价(1,3)-β-D葡聚糖检测(G试验)在慢性阻塞性肺疾病(COPD)合并侵袭性肺部真菌感染(IPFI)诊断中的应用价值。方法选取有IPFI高危因素的96例COPD患者,将患者分为IPFI组与非IPFI组。对纳入研究者进行G试验,并同时留取患者痰液做传统方法(痰涂片和真菌培养)的检查。通过受试者工作特征曲线(ROC)计算G试验和传统方法的曲线下面积,比较两项检查的灵敏度、特异度、阳性预测值、阴性预测值和曲线下面积。结果以20pg/mL为临界值,IPFI组的(1,3)-β-D葡聚糖浓度明显高于非IPFI组,差异有统计学意义(P<0.05),G试验的灵敏度、特异度、阳性预测值、阴性预测值分别为89.5%、89.6%、68.0%、97.2%。G试验和传统方法的ROC曲线下面积分别为0.942和0.790。结论 G试验较传统方法简便、省时且阳性率高,可作为COPD合并IPFI早期诊断指标为临床提供诊疗依据。

Objective To evaluate the value of （1 ,3）‐β‐D‐glucan（G test） in the diagnosis of invasive pulmonary fungal infection （IPFI）in patients with chronic obstructive pulmonary disease （COPD） .Methods 96 COPD patients with high risk of IPFI were en‐rolled in the study ,and were divided into IPFI group and non‐IPFI group .The G test were performed on those people while the tra‐ditional methods sputum smear and fungal culture were also performed .The （1 ,3）‐β‐D‐glucan concentrations of IPFI group and non‐IPFI group were compared ,and then the areas under receiver operating characteristic curve （ROC） were calculated .The sensi‐tivity ,specificity ,positive predictive value ,negative predictive value ,and the area under ROC of the two methods （G test and tradi‐tional methods） were compared .Results The sensitivity ,specificity ,positive predictive value ,negative predictive value of G test were 89 .5% ,89 .6% ,68 .0% ,97 .2% ,respectively ,when 20 pg/mL was the critical value .Areas under curve were 0 .942 for G test ,and 0 .790 for traditional method .Conclusion The detection of （1 ,3）‐β‐D‐glucan might be faster and with higher positive rate than traditional method ,and could be used for the early diagnosis of IPFI ,provide reference for the treatment .