联合检测血浆及支气管肺泡灌洗液(1-3)β-D-葡聚糖对侵袭性肺部真菌感染的临床诊治价值

Clinical Diagnosis and Treatment Value of Joint Detection of Plasma and Bronchoalveolar LavageFluid(1-3)β-D-glucan in Invasive Pulmonary Fungal Infection

目的:探讨联合检测血浆及支气管肺泡灌洗液(BALF)(1-3)β-D-葡聚糖对侵袭性肺部真菌感染的临床诊治价值。方法:选取2014年6月-2016年5月期间本院确诊治疗的侵袭性肺部感染患者100例作为感染组,依据病原菌性质分为真菌组42例和细菌组58例,同期选取体检中心健康人员30例作为健康组。采用乳胶增强免疫比浊法检测(1-3)β-D-葡聚糖水平(G试验),ROC曲线分析血浆及BALF的G试验对侵袭性肺部真菌感染的诊断价值,统计分析所有研究对象血浆、BALF的G试验情况。结果:真菌组患者血浆、BALF的G试验水平明显高于健康组和细菌组,比较差异均有统计学意义(P<0.05)。ROC曲线分析显示,BALF的G试验以10 ng/L为临界值时,诊断侵袭性肺部真菌感染的敏感度、特异度、准确度分别为76.83%、89.73%、84.59%;血浆G试验以20 ng/L为临界值时,其诊断敏感度、特异度、准确度分别为78.47%、91.68%、84.43%;两者联合时,其诊断敏感度、特异度、准确度分别为85.92%、96.41%、93.28%。在诊断敏感度、特异度、准确度方面比较,BALF的G试验<血浆G试验<两者联合,比较差异有统计学意义(P<0.05)。结论:血浆及BALF的G试验水平变化与侵袭性肺部真菌感染有关,联合检测其水平对侵袭性肺部真菌感染具有更为良好的敏感性、特异性和准确性,值得临床作进一步推广。

Objective： To discuss the clinical diagnosis and treatment value of joint detection of plasma and bronchoalveolar lavage fluid （BALF）（ 1-3 ） β-D-glucan in invasive pulmonary fungal infection.Method： 100 patients with invasive pulmonary infection were selected from June 2014 to May 2016 in our hospital as infection group.According to the nature of pathogen, all patients were divided into fungal group of 42 cases and bacteria group of 58 cases, at the same time 30 cases with healthy physical examination center were chosen as health group. The latex enhanced immune turbidimetric method was used to detect （ 1-3 ） β-D-glucan level （ G test ）, ROC curve analysis was used to analyze blood plasma and BALF G test value to the diagnosis of invasive pulmonary fungal infection, all the research objects of blood plasma and BALF G test were analysed.Result： Fungal group G test levels of plasma and BALF were obviously higher than that of healthy group and bacteria group, the differences were statistically significant （ P〈0.05 ） .ROC curve analysis showed that, the BALF G test with 10 ng/L as the critical value of invasive pulmonary fungal infection, the diagnostic, sensitivity and accuracy of the specific degree were 76.83%, 89.73% and 76.83% respectively; the plasma G test with 20 ng/L as the critical value, the diagnostic, sensitivity and accuracy of the specific degree were 78.47%, 91.68% and 84.43% respectively; the two joint as the critical value, diagnostic, sensitivity and accuracy of the specific degree were 85.92%, 96.41% and 93.28% respectively.In the diagnosis of sensitivity, accuracy and specific degree, BALF G experiment〈plasma G〈the two joint, the differences were statistically significant （ P〈0.05 ） .Conclusion： Plasma and BALF G test levels changes associated with invasive pulmonary fungal infection, joint detection the level of invasive pulmonary fungal infection has better sensitivity, specificity and accuracy, it＇s worth for further clinical promotion.