真菌(1,3)-β-D-葡聚糖检测在侵袭性真菌感染中临床应用分析

Clinical application of (1-3)-β-D-glucan assay to invasive fungal infections

目的探讨真菌(1,3)-β-D-葡聚糖检测(G试验)在侵袭性真菌感染患者中临床应用情况。方法回顾性分析湖南省人民医院、中南大学湘雅二医院和中南大学湘雅三医院2014年7月-2015年12月间进行G试验检测的2 588例患者血清标本的阳性率、阴性率、阳性似然比及阴性似然比,分析其临床相关因素。结果 2 588例患者中具有侵袭性真菌感染高危因素者1 678例,占64.84%,无高危因素者910例,占35.16%。在有高危因素患者中G试验检测真阳性169例,假阳性420例,真阴性904例,假阴性185例。阳性似然比为1.51,阴性似然比为0.76。G试验应用于存在血液系统恶性疾病、移植状态、重症感染、自身免疫病、慢性肾功能不全、恶性肿瘤、糖尿病、肝硬化、慢性呼吸系统疾病等9种具有侵袭性真菌感染高危因素的患者检测时阳性似然比分别为1.23、1.77、1.21、1.55、1.31、0.68、1.8、1.97、2.2;阴性似然比分别为0.91、0.64、0.86、0.66、0.75、1.18、0.72、0.64、0.76。结论 G试验临床应用价值有待考证,尤其是在患有血液系统恶性疾病、重症感染、恶性肿瘤的患者中,G试验应用价值较低,需改良其方法。

Objective To investigate the clinical application of （1-3） -β-D-glucan assay to patients with invasive fungal infec- tions. Methods We retrospectively analyzed the positive rate, negative rate, positive likelihood ratio, negative likelihood ratio and their clinical related factors in 2,588 serum specimens detected by （1-3） -β-D-glucau assay and collected from patients in Hu- nan Provincial People＇ s Hospital, the Second Xiangya Hospital of Central South University and the Third Xiangya Hospital of Central South University from July 2014 to December 2015. Results Among the 2,588 patients detected, there were 1,678 （ 64.84% ） ca- ses with high risk factors and 910 （35.16% ） eases without. Among the 1,678 patients with high risk factors, there were 169 true pos- itive cases, 420 false positive cases, 904 true negative cases and 185 false negative cases. The positive likelihood ratio was 1.51, while the negative likelihood ratio 0.76. When （ 1-3） -β-D-glucan assay was applied to the patients with hematologic malignancies, transplant status, severe infection, autoimmune disease, chronic renal failure,malignant tumor,diabetes mellitus,eirrhosis and chron- ic respiratory disease, the positive likelihood ratios were 1.23, 1.77, 1.21, 1.55, 1.31, 0.68, 1.8, 1.97 and 2.2 respectively, and the negative likelihood ratios were 0.91, 0.64, 0.86, 0.66, 0.75, 1.18, 0.72, 0.64 and 0.76 respectively. Conclusions The value of （ 1-3 ） -β-D-glucan assay still needs to be verified in clinical trials. Its clinical value is lower in patients with hematologic malignan- cies, severe infection and malignant tumor; and hence, this method needs to be improved.