G试验联合GM试验在儿童恶性血液病侵袭性真菌感染的诊断价值

Value of G test combined with GM test in diagnosis of invasive fungal infection in children with malignant hematological diseases

目的探讨1,3-β-D-葡聚糖检测(G试验)联合曲霉半乳甘露聚糖检测(GM试验)对儿童恶性血液病侵袭性真菌感染(IFI)的诊断价值。方法恶性血液病患儿421例分为IFI组(86例)和非IFI组(335例),应用MB-80微生物动态快速检测系统和ELISA法分别检测血浆1,3-β-D葡聚糖以及血清曲霉半乳甘露聚糖含量。G试验和GM试验分别以20pg/ml和0.5pg/ml作为诊断界值,计算单独和联合应用诊断IFI的敏感性、特异性、阳性预测值和阴性预测值。结果 G试验的敏感性、特异性、阳性预测和阴性预测值分别为80.2%、89.0%、65.1%和97.7%;GM试验的敏感性、特异性、阳性预测和阴性预测值分别为65.1%、76.7%、36.4%和89.5%;G试验和GM试验联合检测IFI的敏感性、特异性、阳性预测和阴性预测值分别为100%、70.7%、46.7%和100%。G试验和GM试验联合检测IFI的敏感性高于单一G试验或GM试验(P<0.05)。结论与单一G试验或GM试验比较,联合检测诊断IFI的敏感性高,是诊断儿童恶性血液病IFI的高效方法。

Objective To explore the value of 1,3-β-D-glucan assay（ G test） combined with aspergillus galactomannan detection（GM test） in the diagnosis of invasive fungal infection（IFI） in children with malignant hematological diseases. Methods A total of 421 children with malignant hematological diseases was divided into two groups of IFI（86 cases） and non-IFI（335 cases）. MB-80 rapid detection system and ELISA were used to detect plasma levels of 1,3-β-D-gluean and aspergillus galactomannan. Taking 20 pg/ml for G test and 0.5 pg/ml for GM test as the cutoff values, the sensitivity,specificity, positive predictive value and negative predictive value of IFI were calculated. Results The sensitivity, specificity,positive predictive value and negative predictive value of G test for the diagnosis of IFI were 80.2%, 89.0%, 65.1% and 97.7%, which of GM test were 65. 1%, 76.7%,36.4% and 89.5%,and of G test combined with GM test were 100%,70. 7%,46.7% and 100%,respectively. The sensitivity of G test combined with GM test for the diagnosis of IFI was higher than that of G test or GM test alone（P〈0. 05）. Conclusion G test combined with GM test is a highly effective method for the diagnosis of IFI in children with malignant hematological diseases.