支气管肺泡灌洗液（1，3）-β-D葡聚糖检测对重症患者侵袭性肺部真菌感染的疗效评价

Value of β-（1-3）-D-glucan in bronchoalveolar lavage fluid in evaluation of therapeeutic effects of invasive pulmonary fungal infection

目的研究支气管肺泡灌洗液（BALF）G试验在对治疗危重症患者侵袭性肺部真菌感染（IPFI）疗效评估的价值。方法选取2012年6月1日～2014年6月1日期间东莞东华医院重症医学科临床诊断IPFI患者，对所有入选病例使用抗真菌药物进行抢先治疗，分别在治疗后第3天，第7天，第10天，第14天留取支气管肺泡灌洗液BALFG试验、留取血液标本做血清G试验。对其进行回顾性研究，根据临床转归情况分有效组与无效组，分别比较两组在不同治疗时间点留取的标本与治疗前BALFG试验、血清G试验结果。结果治疗后G试验结果变化与疗效有明显的关系。在治疗有效组中，无论BALFG试验还是血清G试验结果均较治疗前有所下降；而在无效组中，BALFG试验及血清G试验结果均有所上升。治疗3aM，在治疗有效组中，BALFG试验较治疗前留取的标本检验结果差异有统计学意义，P〈0．05；血清G试验结果较治疗前比较，差异无统计学意义。结论BALF的G试验能有效提高对IPFI患者治疗的疗效评估的敏感性，对协助侵袭性真菌感染患者的诊治过程的疗效评价乃致对治疗措施的作出及时合理调整起到较大指导作用。

Objective To study the therapeutic evaluation of bronchoalveolar lavage fluid （BALF） G-test in the treatment of invasive pulmonary fungal infections （IPFI） . Methods Thirty-nine patients in ICU diagnosed as with IPFI underwent treatment with antifungal drugs and divided into 2 groups according to the clinical manisfestation： effective group （n=30） and non-effective grou （n=9）. BALF and blood samples were collected before treatment, and 3, 7, 10, and 14 days after treatment respectively to underego detection of β-（1-3）-D-glucan by restrospective analysis method. Results In the effective group, the BALF levels 3 days later were significantly lower than those before treatrment and then coninued to decrease （all P 〈0.05）, but there was no significant differences in the serum [^-（1-3）-D-glucan levels 3 days later than those before treatment （all P 〉0.05）. Conclusion BALF G test helps diagnose IPFI and evaluate the curative effect thereof.