1-3-β-D葡聚糖和半乳甘露聚糖检测与血培养真菌结果的相关性分析

Correlation analysis between(1,3)-β-D glucan and galactomannan detection and blood culture fungal results

目的探讨血清1,3-β-D葡聚糖检测(G试验)和半乳甘露聚糖抗原检测(GM试验)对侵袭性真菌病(IFD)诊断的灵敏度、特异度等临床诊断性能。方法对该院2017年3月至2018年6月间同时做了G试验、GM试验和真菌血培养的住院患者结果进行回顾性相关分析,收集临床疑似IFD病例共455例。以血培养真菌阳性作为IFD确诊指标,将病例分为IFD组和非IFD组,其中IFD组49例;非IFD组406例;分析G试验和GM试验诊断侵袭性真菌感染的灵敏度、特异度、阳性预测值、阴性预测值、约登指数、符合率等效能指标。结果 IFD组G试验和GM试验检测值为(243.7±268.3)pg/mL和0.47±0.70;非IFD组G试验和GM试验检测值为(23.1±52.3)pg/mL和0.25±0.24,两组间比较差异有统计学意义(P<0.001)。G试验和GM试验对IFD诊断的灵敏度、特异度、阳性预测值、阴性预测值、约登指数、符合率分别为65.3%、95.3%、62.7%、95.7%、0.606、92.1%和24.5%、93.6%、31.6%、91.1%、0.181、86.2%;G试验与GM试验联合诊断IFD的特异性达99.0%。结论 G试验与GM试验是IFD早期诊断的实验室重要指标,联合检测可提高诊断灵敏度和准确度;特别是阴性结果对排除IFD的意义更大,对其合理应用可有效提高IFD的诊治水平。

Objective To explore the sensitivity,specificity,and other clinical diagnostic performance for the diagnosis of invasive fungal disease (IFD) in serum (1,3)-β-D glucan detection(G test)and galactomannan antigen (GM test). Methods A retrospective analysis was performed on the results of inpatients with G test,GM test,and fungal blood culture conducted at the First Affiliated Hospital of Chongqing Medical University from March 2017 to June 2018.A total of 455 suspected suspected IFDs were collected.Postive blood culture fungal was used as diagnostic index to confirm IFD,all cases were divided into IFD group ( n =49) and non-IFD group ( n =406).The sensitivity,specificity,positive predictive value,negative predictive value,Yoden index and coincidence rate of G test and GM test in the diagnosis of invasive fungal infection were analyzed. Results The detection values of G test and GM test in the IFD group were (243.7±268.3)pg/mL and 0.47± 0.70 .The detection values of G test and GM test in the non-IFD group were (23.1±52.3)pg/mL and 0.25± 0.24,and there was a statistically significant difference between the two groups ( P <0.001).The sensitivity,specificity,positive predictive value,negative predictive value,Yorden index,coincidence rate of G test and GM test for IFD diagnosis were respectively 65.3%,95.3%,62.7%,95.7%,0.606,92.1%,and 24.5%,93.6%,31.6%,91.1%,0.181,86.2%.The specificity of combined G test and GM test in diagnosing IFD was 99.0%. Conclusion G test and GM test are important laboratory indicators for early diagnosis of IFD.Joint detection can improve the sensitivity and accuracy of diagnosis.Especially,the negative results are more significant for excluding IFD.Rational application of the negative results can effectively improve the level of diagnosis and treatment of IFD.