GM试验和G试验对侵袭性肺部真菌感染的诊断价值及临床疗效评价

Roles of GM test and G test for the diagnosis of invasive pulmonary fungal infection and its clinical treatment efficiency

目的探讨半乳甘露聚糖(GM)试验和(1,3)-β-D-葡聚糖(G)试验对临床侵袭性肺部真菌感染(IPFI)的诊断价值。方法采用GM试验和G试验分别检测IPFI患者GM和G抗原水平,计算GM和G试验的敏感性、特异性、阳性预测值、阴性预测值、准确性和漏诊率等指标。查阅病历回顾性调查IPFI患者的年龄、科室、并发疾病、真菌种类、相关感染指标和药物疗效。结果在435例IPFI患者中,男性占63.0%,女性占37.0%。年龄(55.3±26.6)岁,50岁以上者占64.1%。呼吸内科、儿科和重症监护室(ICU)患者较多,分别占30.6%、17.5%和14.2%。重症肺炎和慢性阻塞性肺疾病(COPD)等呼吸系统感染性疾病患者占31.5%。分离出烟曲霉88株,白念珠菌36株、热带念珠菌12株、光滑念珠菌6株。C反应蛋白(CRP)、降钙素原(PCT)、D-二聚体(DD)升高率依次为77.0%、91.6%、82.9%。敏感性、特异性、阳性预测值、阴性预测值、准确性和漏诊率GM试验分别为86.3%、93.0%、91.4%、88.7%、89.9%和13.7%,G试验分别为78.3%、77.2%、80.4%、74.9%、77.8%和21.7%。GM试验和G试验的阳性率分别为34.7%和42.3%,二者差异无统计学意义(P>0.05)。伏立康唑平均有效率为81.4%,卡泊芬净平均有效率为58.8%。结论 GM和G试验对IPFI的诊断有较大价值。小儿和50岁以上的老年男性、重症肺炎、COPD、血液病、风湿免疫性疾病、脑出血、脑梗死、尿毒症、肿瘤、烟曲霉感染及白念珠菌感染是IPFI的危险因素。经验选用伏立康唑和卡泊芬净治疗IPFI的疗效较好。

ObjectiveTo investigate the roles of galactomannan （GM） test and（1,3）-beta-D-glucan （G）test for patients with invasive pulmonary fungal infection （IPFI）. MethodsThe antigen levels of GM and G were determined by GM test and G test,respectively. The sensitivities,specificities,positive predictive values,negative predictive values,accuracies and missed diagnosis rates of GM test and G test were calculated. The information of IPFI patients,including age,department,concurrent disease,fungus species,correlation infection index and drug treatment efficiency,were analyzed retrospectively. Results There were 435 positive cases,and the proportions of males and females accounted for 63.0% and 37.0%,respectively. The age was （55.3±26.6）years old,and the patients over 50 years old accounted for 64.1%. The departments of respiratory,pediatrics and intensive care unit （ICU） accounted for 30.6%,17.5% and 14.2%,respectively. The proportions of severe pneumonia and chronic obstructive pulmonary disease （COPD） patients accounted for 31.5%. There were 88 isolates of Aspergillus fumigatus,36 isolates of Calbicans,12 isolates of Candida tropicalis and 6 isolates of Candida glabrata. The increase rates of C-reactive protein （CRP）,procalcitonin （PCT） and D-dimer （DD） were 77.0%,91.6% and 82.9%,respectively. The sensitivity,specificity,positive predictive value,negative predictive value,accuracy and missed diagnosis rate ofGM test were 86.3%,93.0%,91.4%,88.7%,89.9% and 13.7%,and those of G test were 78.3%,77.2%,80.4%,74.9%,77.8% and 21.7%,respectively. The positive rates of GM test and G test were 34.7% and 42.3%（P〉0.05）. The effective rates of voriconazole and caspofungin were 81.4% and 58.8%. Conclusions GM test and G test play roles in the clinical diagnosis of IPFI. The risk factors of IPFI include children,elderly male patients over 50 years old,severe pneumonia,COPD,blood diseases, rheumatic autoimmune disease,cerebral hemorrhage,cerebral infarction,uremia,tumor,Aspergillus fumigatus infection and Calbicans infection. Voriconazole and caspofungin are good treatment options.