真菌荧光染色在侵袭性真菌病中的应用价值

Value of fungal fluorescent staining in invasive fungal diseases

目的评估真菌荧光染色在侵袭性真菌病诊断中的临床价值。方法选取2018年1月至2021年12月宁波大学医学院附属医院呼吸与危重症科收治的高度怀疑侵袭性肺部真菌感染的住院患者资料170例,回顾性分析患者肺泡灌洗液(bronchoalveolar lavage fluid,BALF)经真菌荧光染色、氢氧化钾湿片法、革兰染色的检测结果,分别计算3种方法的检出率和阳性率;回顾性分析血清(1,3)-β-D葡聚糖检测(G试验)、肺泡灌洗液半乳甘露聚糖(galactomannan,GM)试验和肺泡灌洗液隐球菌荚膜多糖抗原检测的敏感度、特异性、阳性和阴性预测值,并与真菌荧光染色进行对比。结果170例患者中,90例被临床诊断为侵袭性肺部真菌感染,80例为非侵袭性肺部真菌感染。真菌荧光染色的检出率和阳性率均高于氢氧化钾湿片法和革兰染色;其中有136例患者同时进行了肺泡灌洗液真菌荧光染色和血清G试验,敏感度分别为51.5%、14.7%,特异性分别为88.2%、92.6%;66例患者同时进行了肺泡灌洗液真菌荧光染色和GM试验,敏感度分别为64.1%、38.5%,特异性分别为85.2%、59.3%;76例患者同时进行了肺泡灌洗液真菌荧光染色和隐球菌荚膜多糖抗原检测,敏感度分别为27.9%、81.4%,特异性分别为97.0%、97.0%。结论真菌荧光染色在侵袭性真菌病的诊断中具有重要的临床价值。

Objective To evaluate the clinical value of fluorescence staining in the diagnosis of invasive fungal diseases.Methods The data of 170 inpatients with high suspicion of invasive pulmonary fungal infections admitted to the Department of Respiratory and Critical Care of the Affiliated Hospital of Ningbo University School of Medicine from January 2018 to December 2021 were selected,and the detection results of patients'alveolar lavage fluid(BALF)by fungal fluorescence staining,potassium hydroxide(KOH)wet film method and Gram staining were retrospectively analyzed.Methods The data of 170 inpatients with high suspicion of invasive pulmonary fungal infections admitted to the Department of Respiratory and Critical Care of the Affiliated Hospital of Ningbo University School of Medicine from January 2018 to December 2021 were selected,and the detection results of patients'alveolar lavage fluid(BALF)by fungal fluorescence staining,potassium hydroxide(KOH)wet film method and Gram staining were retrospectively analyzed.The sensitivity,specificity,positive and negative predictive values of serum(1,3)-β-D glucan(G/test,galactomannan(GM)test and cryptococcal polysaccharide antigen test in alveolar lavage fluid were analysed and compared with fungal fluorescent staining.Results Of the 170 patients,90 were clinically diagnosed with invasive pulmonary fungal infections and 80 with non-invasive pulmonary fungal infections.The detection and positivity rates of fungal fluorescent staining were higher than those of KOH wet film method and Gram staining;among them,136 patients underwent both alveolar lavage fluid fungal fluorescent staining and serum G test,and the sensitivity and specificity of both were 51.5%and 14.7%,respectively,and 88.2%and 92.6%,respectively;66 patients underwent both alveolar lavage fluid fungal fluorescent staining and GM test,and the sensitivity and specificity of both were The sensitivity and specificity were 64.1%,38.5%and 85.2%,59.3%respectively.76 patients underwent both alveolar lavage fluid fungal fluorescent staining and cryptococcus podococcal polysaccharide antigen testing,and the sensitivity and specificity were 27.9%,81.4%and 97.0%,97.0%respectively.Conclusion Fluorescence staining has important clinical value in the diagnosis of invasive fungal disease.