血清(1-3)-β-D-葡聚糖检测对深部真菌感染辅助诊断的临床价值

Clinical Evaluation of( 1,3)-β-D-glucan in the Diagnosis of Invasive Fungal Infection

目的:探讨血清(1-3)-β-D-葡聚糖(BDG)检测对深部真菌感染辅助诊断的价值。方法:对我院2014年336例疑似深部真菌感染病例分别进行血清BDG检测和真菌培养鉴定;对比分析血清BDG检测和真菌培养的敏感性、特异性、阳性预测值及阴性预测值。结果:BDG检测阳性171例,阳性率为50.89%(171/336);真菌培养阳性141例,阳性率为41.96%(141/336)。真菌培养阳性组血清BDG含量为(131.18±102.91)pg/m L,真菌培养阴性组血清BDG含量为(45.06±33.64)pg/m L,两组差异有统计学意义(t=9.57,P<0.01)。以真菌培养结果为标准,BDG检测的敏感性为54.61%(77/141),特异性51.79%(101/195);阳性预测值和阴性预测值分别为45.03%(77/171)和61.21%(101/165)。真菌培养显示白念珠菌仍然是临床深部真菌感染的主要病原菌。结论:BDG检测可实现疑似深部真菌感染的快速诊断,但对(1-3)-β-D-葡聚糖阳性结果需辅以真菌培养鉴定,两者联合使用具有较高的临床应用价值。

Objective：To evaluate the clinical value of（1, 3）-β-D-glucan （BDG） on the diag-nosis of invasive fungal infection.Methods：The suspected invasive fungal infection patients from Sun Yet-sen memorial hospital were enrolled in this study.The blood samples were taken from each patient and tested by determination of （1, 3）-β-D-glucan and culture.The sensitivity, spe-cificity, positive predictive value and negative predictive value were compared between these two methods.Results：171 patients were identified as positive by the detection of plasma BDG, with the positive rate of 50.89%（ 171/336 ） .141 samples were identified as positive by fungal cul-tures, with the positive rate of 41.96%（141/336） .The concentration of plasma BDG in the inva-sive fungal infection group with positive fungal culture was （131.18 ±102.91） pg/mL, w hile the concentration of plasma BDG in invasive fungal infection group with negative fungal culture was （45.06 ±33.64 ） pg/mL.There were statistically significant differences in the concentration of plasma BDG between the two groups（t=9.57, P〈0.01）.Based on the results of the fungal cul-tures, the sensitivity, specificity, and positive and negative predictive values for BG were 54.61%（77/141）, 51.79%（101/195）, 45.03%（71/171） and 61.21%（101/165）, respectively.The genus of Candida is still the predominant pathogens of invasive fungal infection.Conclusions：The determination of plasma （1, 3）-β-D-glucan could be used as an fast tool for invasive fungal infec-tion diagnosis, but the results need to be confirmed by culture.The combination of both methods could be used for routine diagnosis of invasive fungal infection in clinic.