血浆(1-3)-β-D葡聚糖对院内侵袭性真菌感染诊断的临床价值

Clinical significance of plasma(1-3)-β-D glucan for diagnosis of invasive fungal infection

目的探讨血浆(1-3)-β-D葡聚糖(即G实验)对院内侵袭性真菌感染的临床价值。方法选择2016.11~2017.4在宁夏医科大学总医院住院患者中院内侵袭性真菌感染的高危患者132例,血浆(1-3)-β-D葡聚糖含量使用MB-80微生物快速检测动态系统及其试剂进行检测,用ROC曲线比较G实验、真菌培养、G实验联合真菌培养的检测结果。结果 132例高危院内IFI感染的患者中,共有43例诊断为院内侵袭性真菌感染,真菌培养的敏感度为67%,特异度为96%,阳性预测值(PPV)和阴性预测值(NPV)分别是0.72和0.80,G实验的敏感度为70%,特异度为88%,PPV和NPV分别是0.73和0.86;G实验真菌培养检测的敏感度提高为84%,特异度提高为92%,阳性预测值0.78,阴性预测值0.92;G实验Youden指数0.58,真菌培养Youden指数0.63,联合检测Youden指数提高到0.76;G实验结果、真菌培养结果及联合检测结果进行ROC曲线分析,曲线下面积分别为0.717,0.757及0.798。结论 G实验是一种快速、简便、实用的侵袭性真菌感染的早期诊断方法,联合传统真菌培养可提高诊断的敏感度、特异度及诊断价值。

Objective To explore the diagnostic value of plasma（1-3）-β-D-glucan test in the nosocomial invasive fungal infection（IFI）.Methed The MB-80 microbial dynamics detection system was used to conduct the G test in 132 inpatients with suspected nosocomial IFI in the General Hospital of NingXia Medical University from September 2016 to April 2017.Meanwhile,the result of the conventional fungal culture and the result of combined detection were analyzed by ROC curve.Results Among 132 cases,43 cases were diagnosed as IFI.The sensitivity of fungal culture was 67%,the specificity was96%,PPV and NPV were 0.72 and 0.80.The sensitivity of G Test was 70%,the specificity was 88%,PPV and NPV were0.73 and 0.86.Combined the fungal culture and G test,the sensitivity was improved to 84%,the specificity was improved to92%.The Youden exponents of fungal culture,G test and combined detection were 0.63,0.58 and 0.76.The areas under the ROC curves of fungal culture,G test and combined detection were 0.757,0.717 and 0.798.Conclusion G test was a simple,rapidly practical early diagnostic method of fungial infection.The combined detection could increase the sensitivity,specificity and diagnostic value for diagnosing nosocomial IFI.