(1-3)β-D-葡聚糖水平对侵袭性肺部真菌感染的诊断效能分析

Diagnostic Efficiency Analysis of( 1-3)β-D-dextran Levels for Invasive Pulmonary Fungal Infections

目的:探讨(1-3)β-D-葡聚糖水平对侵袭性肺部真菌感染的诊断效能。方法:选取本院2013年1月-2015年1月呼吸内科侵袭性肺部真菌感染患者119例作为真菌感染组,同期选取肺部细菌感染患者116例作为细菌感染组、健康体检者115例作为对照组,采用免疫比浊法检测支气管肺泡灌洗液(BALF)和血浆(1-3)β-D-葡聚糖(G试验),以真菌培养法作为IPFI的诊断金标准,分析BALF G试验、血浆G试验及联合两者G试验的诊断阳性率、阴性率、灵敏度、特异度、阳性预测值、阴性预测值和准确度。结果:真菌感染组BALF和血浆(1-3)β-D-葡聚糖水平均明显高于细菌感染组和对照组,组间比较差异均有统计学意义(P<0.05),其中细菌感染组与对照组BALF和血浆(1-3)β-D-葡聚糖水平比较差异无统计学意义(P>0.05)。真菌培养阳性99例,真菌培养阴性20例,其中真菌培养阳性者BALF和和血浆(1-3)β-D-葡聚糖水平分别为(18.45±5.01)ng/L、(90.26±6.25)ng/L;明显高于真菌培养阴性者的(2.03±0.02)ng/L、(77.94±5.01)ng/L,两者比较差异均有统计学意义(t=14.61、8.28,P<0.001)。BALF+血浆G试验对IPFI的诊断阳性率、灵敏度、阴性预测值和准确度均明显高于单独BALF G试验和血浆G试验,比较差异均有统计学意义(P<0.05)。结论:BALF联合血浆(1-3)β-D-葡聚糖水平检测操作简便、快速,且显著提高对侵袭性肺部真菌感染的诊断阳性率、灵敏度和准确度,值得临床推广应用。

Objective：To investigate the diagnostic efficiency analysis of（1-3）β-D-dextran levels for invasive pulmonary fungal infections.Method：119 patients with invasive pulmonary fungal infections from respiratory internal medicine department of our hospital from January 2013 January 2015 were selected as the fungal infection group,at the same period,116 patients with pulmonary bacterial infection were selected as the bacterial infection group,115 cases of health examined people were selected as the control group,bronchoalveolar lavage fluid（BALF） and plasma（1-3）β-D-dextran levels（G test） were detected by immune turbidimetric method and fungal culture results were as diagnostic gold standard,the diagnostic positive rate and negative rate,sensitivity,specificity,positive predictive value and negative predictive value and accuracy of BALF,plasma G test and combined the two G test were analyzed.Result：The BALF and plasma（1-3）β-D-dextran levels of fungal infection group were significantly higher than bacterial infection group and control group,the differences were statistically significant（P〈0.05）,there were no statistically significant differences in BALF and plasma（1-3）β-D-dextran levels between bacterial infection group and control group（P〉0.05）.Fungal culture positive was 99 cases,fungal culture negative was 20 cases,BALF and plasma（1-3）β-D-dextran levels of fungal culture positive were respectively（18.45±5.01）ng/L and（90.26±6.25）ng/L,which were significantly higher than（2.03±0.02）ng/L and（77.94±5.01）ng/L of fungal culture negative,the differences were statistically significant（t=14.61,P〈0.001;t=8.28,P〈0.001）.The positive diagnosis rate,sensitivity,negative prediction value and accuracy of BALF combined plasma G test were significantly higher than simply BALF G test or simply plasma G test,the differences were statistically significant（P〈0.05）.Conclusion：BALF combined plasma（1-3）β-D-dextran levels detection is simple,fast,and it can significantly improve the diagnostic positive rate,sensitivity and accuracy of invasive pulmonary fungal infection,it is worthy of clinical application.