血清(1,3)-β-D-葡聚糖检测对深部真菌病诊断的研究

Study on diagnostic value of serum (1,3)-β-D-Glucan detection for deep fungal disease

目的探讨血清（1,3）-β-D-葡聚糖对深部真菌病的诊断价值。方法将2014年2~6月天津市武警后勤学院附属医院110份数据（标本140份）分为侵袭性真菌病患者组33例和无侵袭性真菌病组77例,分析比较葡聚糖水平,并使用ROC曲线确定最佳临界值。结果侵袭性真菌病患者组的葡聚糖水平（279.78±83.26）pg/m L,明显高于对照组（34.05±9.35）pg/m L（P〈0.001）;ROC曲线下面积为0.946（95%的置信区间为0.904~0.988）,当以95.20 pg/m L为临界值时,实验的敏感度、特异度、阳性预测值和阴性预测值分别为84.8%、93.5%、80.0%和93.3%;临床符合率达到89.1%。Kappa值0.784（P〈0.05）。结论血清葡聚糖水平可以用于深部真菌感染的诊断,本研究中用北京金山川公司的GKT-1M Set动态真菌检测试剂盒检测血清葡聚糖水平,进行深部真菌感染诊断时的最佳临界值为95.20 pg/m L,当以此临界值对深部真菌感染进行诊断时,临床一致性较好。

Objective To investigate the diagnostic value of serum（1,3）-β-D-glucan for deep fungal disease. Methods110 copies of data（140 specimens） of affiliated hospital of tianjin Armed Police logistics academy from February to June 2014 were divided into the invasive fungal disease group with 33 copies and the non-invasive fungal disease group with 77 copies. The glucan levels were analyzed and compared. The ROC curve was used to determine the optimal critical value. Results The glucan level of the invasive fungal disease group was（279.78±83.26） pg/m L, which was significantly higher than the（34.05±9.35）pg/m L of the control group（P〈0.001）. The ROC area under curve was 0.946（95% confidence interval was 0.904-0.988）; When 95.20 pg/m L was used as the critical value, the sensitivity, specificity, positive predictive value and negative predictive value of experiment were 84.8%, 93.5%, 80.0% and 93.3%. The clinical accordance rate reached 89.1%. The Kappa value was 0.784（P〈0.05）. Conclusion The serum glucan level can be used for the diagnosis of deep fungal infection. This study uses the GKT-1M Set dynamic fungal detection kit of Beijing Jinshan Company to detect the serum glucan level. The optimal critical value for deep fungal infection diagnosis is 95.20 pg/m L and when this critical value is used for the diagnosis of deep fungal infection, the clinical consistency is better.