G/GM试验联合肺部CT检查对血液病患者侵袭性真菌病的诊断价值

Diagnositc value of G/GM combined with CT examination of the lungs for invasive fungal disease in patients with hematological diseases

目的探讨血清(1,3)-β-D-葡萄糖检测(G试验)、半乳甘露聚糖抗原检测(GM试验)联合肺部CT影像学检查对血液病患者侵袭性真菌病(IFD)的诊断价值。方法回顾性分析2017年6月1日至2018年5月31日存在高危侵袭性真菌感染因素的164例血液病患者的临床症状、真菌检测指标(G试验、GM试验)及肺部CT影像学表现,评价G/GM试验联合肺部CT检查在诊断血液病患者IFD中的价值。结果G试验、GM试验、肺部CT检查单项诊断IFD的灵敏度分别为37.0%、63.0%、44.4%,特异度分别为87.9%、74.8%、97.2%。G/GM试验并联诊断IFD的灵敏度为81.5%,特异度为69.2%。G试验、GM试验、肺部CT检查三者并联诊断IFD的灵敏度为81.5%,特异度为67.3%。G/GM试验并联检测对IFD诊断的灵敏度高于G试验、GM试验、肺部CT单项检查,差异有统计学意义(P<0.05);三者并联检测的灵敏度高于单独G试验、GM试验、肺部CT检查,差异有统计学意义(P<0.05);但三者并联检测与G/GM试验并联检测的灵敏度比较,差异无统计学意义(P=0.062)。肺部CT检查特异性影像改变诊断IFD的特异度明显高于G/GM试验并联及三者并联检测,差异有统计学意义(P<0.05)。结论G/GM试验并联、G/GM试验和肺部CT检查三者并联检测能提高诊断IFD的灵敏度,对诊断IFD具有临床指导意义。

Objective To explore the diagnostic value of serum(1,3)-β-D-glucose(G test),galactomannan antigen(GM test)combind with CT examination of the lungs in invasive fungal disease(IFD)in patients with hematological diseases.Methods The clinical symptoms,fungal detection indicators(G test,GM test)and CT imaging of the Lungs of 164 patients with hematological diseases who had a high risk of invasive fungal infection from June 1,2017 to May 31,2018 were retrospectively analyzed,and the diagnostic value of G/GM test combined with CT examination of the lungs in IFD was evaluated.Results The sensitivities of the G test,GM test,and lung CT were 37.0%,63.0%,and 44.4%,respectively,and the specificites were 87.9%,74.8%and 97.2%,respectively.The sensitivity and specificity of the G/GM test in parallel for diagnosing IFD was 81.5%and 69.2%,respectively.The sensitivity and specificity of G test,GM test,and lung CT examination in parallel for diagnosising IFD was 81.5%and 67.3%,respectively.The sensitivity of G/GM test in parallel for diagnosing IFD was higher than that of the G test,GM test,and lung CT,and the difference was statistically significant(P<0.05).The sensitivity of the three tests in parallel was higher than that of the separate G test,GM test and lung CT examination,and the difference was statistically significant(P<0.05);however,no statistically significant difference was found in the sensitivity between the three tests in parallel and the the G/GM test in parallel(P=0.062).The specificity of CT examination of the lungs was significantly higher than that of the G/GM test in parallel and three tests in parallel(P<0.05).Conclusion The G/GM test in parallel and the combination of G/GM test with CT can improve the sensitivity for diagnosing IFD,whichhas clinical significance for the diagnosis of IFD.