血浆(1-3)-β-D葡聚糖检测诊断艾滋病患者合并播散性马尔尼菲青霉菌病的临床价值

Clinical value of detection of plasma (1-3)-β-D-glucan in diagnosis of AIDS patients complicated with disseminated penicilliosis marneffei

目的：探讨血浆（1‐3）‐β‐D葡聚糖检测对艾滋病（AIDS）患者合并播散性马尔尼菲青霉菌病（DPsM ）的诊断价值，为临床提供早期治疗依据。方法回顾性研究2010年4月－2014年7月174例 AIDS住院患者，分为观察组82例为临床确诊合并播散性马尔尼菲青霉菌病，对照组92例为无机会性感染，运用M B‐80微生物快速动态检测系统进行血浆（1‐3）‐β‐D葡聚糖检测（G试验），比较两组血浆（1‐3）‐β‐D葡聚糖水平，绘制受试者工作特征（ROC）曲线，确定血浆（1‐3）‐β‐D葡聚糖水平诊断播散性马尔尼菲青霉菌病的最佳诊断值。结果观察组和对照组血浆（1‐3）‐β‐D葡聚糖检测浓度中位数分别为198．0 pg／ml和24．0 pg／ml ，两组比较差异有统计学意义（P＜0．05）；ROC曲线分析结果显示，血浆（1‐3）‐β‐D葡聚糖用于诊断播散性马尔尼菲青霉菌病的最佳诊断值为75 pg／m l ，曲线下面积（A U C ）为0．843（95％ C I 0．784～0．903，P＜0．05），灵敏度、特异性、阳性预测值、阴性预测值分别为74．40％、84．80％、81．30％和78．79％。结论血浆（1‐3）‐β‐D葡聚糖检测具有早期诊断播散性马尔尼菲青霉菌病的临床应用价值，最佳诊断值为75 pg／m l。

OBJECTIVE To evaluate the clinical value of detection of the plasma （1‐3）‐β‐D‐glucan in diagnosis of the AIDS patients complicated with disseminated penicilliosis marneffei （DPsM ） so as to provide guidance for early clinical treatment .METHODS A retrospective study was conducted for 174 AIDS patients who were hospitalized from Apr 2010 to Jul 2014 ;82 patients who were clinically diagnosed with complication of DPsM were assigned as the observation group ,while 92 patients with non‐opportunistic infections were set as the control group .The con‐centration of plasma （1‐3）‐β‐D‐glucan （ G test ） was determined by Microbiology Kinetic Rapid Detection System MB‐80 .The plasma （1‐3）‐β‐D‐glucan level was compared between the two groups ,and the receiver operating characteristic（ROC） curve was drafted to determine optimal diagnostic value of （1‐3）‐β‐D‐glucan in diagnosis of DPsM .RESULTS The median concentration of the plasma（1‐3）‐β‐D‐glucan of the observation group was 198 .0 pg/ml ,the control group 24 .0 pg/ml ,and there was significant difference between the two groups （P〈0 .05） .The analysis of ROC curve indicated that the optimal diagnostic value of the plasma （1‐3）‐β‐D‐glucan in diagnosis of DPsM was 75 pg/ml ,the area under the curve（AUC）was 0 .843（95% CI 0 .784‐0 .903 ,P〈 0 .05） ,and the sensitivity ,specificity ,positive predictive value ,and negative predictive value were 74 .40% ,84 .80% ,81 .30% , and 78 .79% ,respectively .CONCLUSION The detection of plasma （1‐3）‐β‐D‐glucan has the clinical value in early diagnosis of DPsM ,with the optimal diagnostic value 75 pg/ml .