肺泡灌洗液G试验对侵袭性肺真菌感染的早期诊断价值

摘要

目的 探讨肺泡灌洗液G试验对侵袭性肺真菌感染(IPFI)的早期诊断价值.方法 选取2014年10月～2016年3月广东省梅州市人民医院呼吸与危重症医学科收治的100例患者作为研究对象,根据患者具体病情分为IPFI组(n=21)、无肺部感染组(n=18)、普通肺部感染组(n=19)、未确诊IPFI组(n=42),采集血浆和肺泡灌洗液标本进行葡聚糖检测试验,比较四组患者血浆和肺泡灌洗液(1,3)-β-D-葡聚糖(BG)浓度及对IPFI预测效果.结果 最终确诊38例IPFI患者真菌感染以曲霉菌(31.6％)、白色假丝酵母菌(26.3％)、光滑假丝酵母菌(21.1％)感染为主.三组患者血浆及肺泡灌洗液BG浓度比较,IPFI组＞普通感染组＞无感染组,差异有高度统计学意义(P＜0.01).未确诊组42例患者血浆及肺泡灌洗液BG浓度均为诊断者＞排除者,差异有高度统计学意义(P＜0.01).血浆BG浓度为85 ng/L时的约登指数=0.85,为最大值,预测IPFI特异度为88.83％,敏感度为96.32％(AUC=0.965,P＜0.01);肺泡灌洗液BG浓度为152.3 ng/L时的约登指数=0.87,为最大值,预测IPFI特异度为91.15％,敏感度为96.32％(A UC=0.973,P＜0.01).结论 肺泡灌洗液G试验对IPFI的最佳诊断临界值是152.3 ng/L,特异度高于血清G试验,值得临床推广应用.%Objective To investigate the value of G test of bronchoalveolar lavage fluid in the early diagnosis of inva sire Pulmonary fungal infection (IPFI).Methods 100 patients with Department of Respiratory and Critical Care Medicine admitted in People's Hospital of Meizhou City,Guangdong Province from October 2014 to March 2016 were selected as research objects,they were divided into IPFI group (n=21),without lung infection group (n=18),common lung infection group (n=19),the not diagnosed with IPFI group (n=42) according to the specific conditions of patients.The plasma and bronchoalveolar lavage fluid samples were tested with dextran,the concentration of IPFI in plasma and bronchoalveolar lavage fluid of four groups and effect of IPFI prediction were compared.Results The final diagnosis of 38 patients with IPFI were infected with Aspergillus (31.6％),Candida albicans (26.3％),smooth Candida (21.1％).The comparison of the three groups of patients with plasma and bronchoalveolar lavage fluid dextran concentration:IPFI group ＞ common infection group ＞ no infection group,the difference was statistically significant (P ＜ 0.01).The concentration of dextran in plasma and bronchoalveolar lavage fluid of 42 patients in the not diagnosed group were diagnostic group ＞ exclusion group,the difference was statistically significant (P ＜ 0.01).When the plasma glucan concentration was 85 ng/L,the diagnosis of IPFI was 0.85,the specificity of IPFI was 88.83％ and the sensitivity was 96.32％ (AUC=0.965,P ＜ 0.01).When the diagnosis of IPFI was 0.87,the best threshold was 152.3ng/L,the specificity of IPFI was 91.15％ and the sensitivity was 96.32％ (AUC=0.973,P ＜ 0.01).Conclusion The best diagnostic value ofG test of bronchoalveolar lavage fluid in the invasive pulmonary fungal infection is 152.3ng/L.Its specificity is higher than the serum G test,it is worthy of clinical promotion and application.