G试验和GM试验联合痰真菌培养对ICU患者侵袭性真菌感染的早期诊断

G-test and GM-test combined with sputum fungal culture for the early diagnosisof invasive fungal infection in intensive care unit patients

目的探讨血清1,3-β-D葡聚糖检测(G试验)及半乳甘露聚糖抗原检测(GM试验)联合痰真菌培养在重症监护病房(ICU)患者侵袭性真菌感染(IFI)早期诊断中的价值。方法选取徐州医科大学附属医院2015年1月—2016年12月重症监护病房(ICU)有高危IFI因素的住院患者,根据IFI的诊断标准将患者分成3组:IFI组(包括确诊及临床诊断)、拟诊IFI组、非IFI组。分析三组患者血清G试验、GM试验和痰真菌培养的结果,评价三者联合检测对IFI的早期诊断价值。结果共调查ICU住院患者264例,其中IFI组56例,拟诊IFI组43例,非IFI组165例。56例诊断IFI患者中,血清G试验阳性46例,GM试验阳性39例,真菌培养阳性34例;三者联合检测的敏感性98.2%、特异性82.4%、阳性预测值65.5%、阴性预测值99.3%、阳性似然比5.58、阴性似然比0.02、Youden指数0.98。三者联合检测的敏感性、阴性预测值均高于G试验、GM试验和痰真菌培养的单独检测,差异均有统计学意义(均P<0.05);但是,三者联合检测的特异性、阳性预测值与单独检测G试验、GM试验和痰真菌培养比较,差异均无统计学意义(均P>0.05)。结论 G试验、GM试验和痰真菌培养三者联合检测能提高ICU患者IFI早期诊断的敏感性,从而指导临床医生早期治疗IFI。

ObjectiveTo evaluate the detection value of serum(1,3)-β-D glucan(G-test)and galactomannan(GM test)combined with sputum fungal culture in the early diagnosis of invasive fungal infection(IFI)in intensive care unit(ICU)patients.MethodsInpatients with high risk factors for IFI in the ICU of the Affiliated Hospital of Xuzhou Medical University between January2015and December2016were chosen,they were divided into3groups according to the diagnostic criteria of IFI:IFI group(including confirmed and clinically diagnosed cases),suspected IFI group,and non IFI group.The results of serum G-test,GM-test,and sputum fungal culture in three groups of patients were analyzed,early diagnostic value in IFI with combined three tests was evaluated.ResultsA total of264ICU patients were investigated,IFI group,suspected IFI group,and non IFI group were56,43,and165cases respectively.Among56cases of confirmed IFI,46,39,and34were positive for G test,GM-test,and fungal culture respectively.The sensitivity,specificity,positive predictive value,and negative predictive value of combined three detection were98.2%,82.4%,65.5%,and99.3%respectively,positive likelihood ratio,negative likelihood ratio,and Youden index were5.58,0.02,and0.98respectively.The sensitivity and negative predictive values of combined three detection were both higher than those of single G-test,GM-test,and sputum fungal culture(all P<0.05);but specificity and positive predictive value of combined three detection were not significantly different from single G test,GM-test,and sputum fungal culture(all P>0.05).ConclusionThe combination of G-test,GM-tests,and sputum fungal culture can improve the sensitivity of early diagnosis of IFI in ICU patients,and guide the clinicians in the early treatment of IFI.