(1-3)-β-D葡聚糖联合降钙素原、CD4^(+)T淋巴细胞多指标在艾滋病患者马尔尼菲篮状菌感染早期诊断临床研究

Clinical study of(1-3)-β-D glucan combined with PCT and CD4^(+)T lymphocyte multiple indicators in early diagnosis of AIDS complicated with Talaromyces marneffei infection

目的探讨(1-3)-β-D葡聚糖联合降钙素原(procalcitonin,PCT)、CD4^(+)T淋巴细胞多指标在艾滋病患者马尔尼菲篮状菌感染早期诊断临床研究。方法回顾性选取我院2020年1月—2022年6月住院的120例艾滋病患者为研究对象。依据实验室结果,将其分为马尔尼菲篮状菌感染确诊组(血或组织液培育养出马尔尼菲篮状菌),简称A组(62例),及马尔尼菲篮状菌感染临床诊断组[根据临床症状、体征、血常规及(1-3)-β-D葡聚糖、PCT、CD4^(+)T淋巴细胞多指标诊断],简称B组(58例)。检测患者(1-3)-β-D葡聚糖、PCT、CD4^(+)T淋巴细胞的表达水平,采用受试者工作特征(receiver-operating characteristic,ROC)曲线下面积(area under the curve,AUC)评估上述指标联合检测对艾滋病患者感染马尔尼菲篮状菌的诊断效能。结果A组的(1-3)-β-D葡聚糖和PCT水平均高于B组,CD4^(+)T淋巴细胞个数低于B组(P<0.05);(1-3)-β-D葡聚糖、PCT、CD4^(+)T淋巴细胞联合检测的AUC为0.933,(1-3)-β-D葡聚糖单独检测的AUC是0.812,PCT单独检测的AUC为0.883,CD4^(+)T淋巴细胞单独检测的AUC是0.810,(1-3)-β-D葡聚糖、PCT和CD4^(+)T淋巴细胞联合检测的AUC皆优于三项单独检测,表明(1-3)-β-D葡聚糖、PCT和CD4^(+)T淋巴细胞联合检测的诊断价值皆优于单一指标诊断,且联合检测的特异度、约登指数分别为92.43%和0.580,均高于三项单独检测。结论(1-3)-β-D葡聚糖联合PCT和CD4^(+)T淋巴细胞多指标对艾滋病马尔尼菲篮状菌感染具有非常高的临床诊断价值,能够帮助医生分析出高危风险患者,及时制定治疗方案,同时也承担预后效果的判断依据,对治疗艾滋病马尔尼菲篮状菌感染具有非常重要的研究价值。

Objective To investigate(1-3)-β-D glucan combined with PCT and CD4^(+)T lymphocyte as multiple indicators in the early diagnosis of AIDS complicated with Talaromyces marneffei infection.Methods A total of 120 patients with AIDS who were hospitalized in our hospital from January 2020 to June 2022 were selected.Based on the laboratory results,they were divided into the group of blood or tissue fluid cultivated Talaromyces marneffei infection(Group A),62 cases;and the group of clinically diagnosed Talaromyces marneffei infection(Group B),58 cases(based on the clinical symptoms,signs,and blood routine combined with the(1-3)-β-D glucan,PCT,and CD4^(+)T lymphocytes multi-indicator diagnosis).The expression levels of(1-3)-β-D glucan,PCT,and CD4^(+)T lymphocytes were detected,and the area under the curve(AUC)of the receiver-operating characteristic(ROC)of the subjects was used to assess the diagnostic efficacy of the combination of the above indexes for the diagnosis of Talaromyces marneffei infection in AIDS patients.Results The levels of(1-3)-β-D glucan and PCT in group A were higher than those in group B,and the number of CD4^(+)T lymphocytes was lower than that in group B(P<0.05);the AUC of the combined assay of(1-3)-β-D glucan,PCT,and CD4^(+)T lymphocytes was 0.933,AUC of(1-3)-β-D glucan alone was 0.812,AUC of PCT alone was 0.883.The AUCs of(1-3)-β-D glucan,PCT and CD4^(+)T lymphocytes were all better than those of the three individual tests,indicating that the diagnostic value of(1-3)-β-D glucan,PCT and CD4^(+)T lymphocytes combination was better than that of every single diagnostic index,and the specificity and Jordon's index of the combined tests were 92.43%and 0.43%,respectively,which were higher than those of the three individual tests.Conclusion The multiple indicators of(1-3)-β-D glucan combined with PCT and CD4^(+)T lymphocyte has a very high clinical diagnostic value for Talaromyces marneffei infection in AIDS,which can help doctors analyze high-risk patients and formulate treatment plans in time,and also assume the judgment basis of prognostic effect.