血浆(1-3)-β-D葡聚糖检测对真菌血流感染的诊断价值

Clinical value of plasma(1-3)-β-D-glucan for diagnosis of fungal bloodstream infection

目的探讨血浆(1-3)-β-D葡聚糖检测(G试验)对真菌血流感染的诊断价值。方法收集海军军医大学(第二军医大学)长海医院2015年1月至2017年12月临床各科室送检的进行真菌血培养和G试验的血液标本。分析264例真菌血培养阳性标本的来源科室分布和菌种分布情况。1 678例同时进行真菌血培养和G试验,以真菌血培养阳性为标准,G试验结果>100.5 pg/mL为阳性,计算G试验诊断真菌血流感染的灵敏度、特异度、阳性预测值、阴性预测值;采用SPSS 19.0软件进行统计学分析,以受试者工作特征(ROC)曲线评估G试验对真菌血流感染的诊断价值。结果 2015-2017年共检出血培养阳性真菌264株,主要分布在肝胆外科(81株)、心血管外科(57株)、急救科(24株)、胸外科(22株)、血液科(16株)等科室;病原菌以假丝酵母菌属为主,其中近平滑假丝酵母菌最多(142株,占53.8%),其次为角膜假丝酵母菌(36株,13.6%)、白假丝酵母菌(20株,7.6%)和热带假丝酵母菌(18株,6.8%)。1 678例同时进行真菌血培养和G试验的患者中,137例真菌血培养结果为阳性。以真菌血培养阳性为标准,G试验诊断真菌血流感染的灵敏度、特异度、阳性预测值、阴性预测值分别为61.3%、87.9%、31.1%、96.2%;ROC曲线分析结果显示,G试验对真菌血流感染的诊断效能较好(曲线下面积为0.771,95%置信区间为0.723~0.819)。137例真菌血流感染病例中,102例在血培养之前2~5 d进行了G试验,其中71例(69.6%)G试验结果为阳性。结论血浆G试验诊断真菌血流感染的特异度较高,对真菌血流感染的早期诊断具有较好的阴性预测价值。

Objective To investigate the clinical value of plasma (1-3)-β-D-glucan test (G test) for diagnosis of fungal bloodstream infection. Methods The blood samples for fungal culturing and G test were collected in Changhai Hospital of Naval Medical University (Second Military Medical University) from Jan. 2015 to Dec. 2017. The department distribution and strain distribution of 264 positive specimens detected by fungal blood culture were analyzed. A total of 1 678 samples were collected during this period for fungal blood culture and plasma G test. Taking fungal blood culture as the criterion, with a cut-off of 100.5 pg/mL for G test, we analyzed the sensitivity, specificity, positive forecast value, and negative forecast value of G test for diagnosis of fungal bloodstream infection. Statistical analysis was performed using SPSS 19.0 software, and the diagnostic value of G test for bloodstream infection was judged by the receiver operating characteristic (ROC) curve. Results A total of 264 strains of fungal blood culture were positive from 2015 to 2017, mainly from the departments of hepatobiliary surgery (81 strains), cardiac surgery (57 strains), emergency (24 strains), thoracic surgery (22 strains), and hematology (16 strains). Candida is the main genus, of which Candida parapsilosis is the most common one, with 142 strains (53.8%), followed by Candida corneum (36 stains, 13.6%), Candida albicans (20 strains, 7.6%) and Candida tropical (18 strains, 6.8%). Taking fungal blood culture as the criterion, we found that the sensitivity, specificity, positive forecast value, and negative forecast value of G test for diagnosis of fungal infection were 61.3%, 87.9%, 31.1%, and 96.2%, respectively. ROC curve analysis showed that G test was valuable for diagnosis of fungal bloodstream infection, with the area under the curve being 0.771 (95% confidence interval: 0.723-0.819). Among 137 cases of bloodstream infection, 102 cases (69.6%) were tested for G test 2-5 d before blood culture, and 71 cases were positive. Conclusion Plasma G test kit is still ideal in terms of specificity and has a certain clinical value for the early diagnosis of fungal bloodstream infection.