血浆1,3-β-D葡聚糖检测对儿童侵袭性真菌感染诊断价值

摘要

Objective To evaluate the diagnostic value of plasma 1,3-p-D glucan ( BG ) assay ( G test) to invasive fungal infection( IFI) in children. Methods By retrospectively accessing the clinical data of pediatric inpatients who underwent G test and the patients were recruited from January 2008 to August 2011. According to the diagnosis standard of IFI, children were divided into IFI group and non-IFI group. G test was performed by the GKT-5M Set Kinetic Fungus Detection Kit. It was judged as positive when the plasma BG level≥10 pg· mL-1. 2 by 2 table was used to calculate the G test for the diagnosis of IFI sensitivity, specificity, positive predictive value and negative predictive values. Receiver operating curve ( ROC ) of G test was analyzed, and the area under the curve was calculated. Results A total of 525 inpatients received G test, 129 of them with suspected IFI diagnosis were excluded. Forty-three patients were diagnosed as IFI ( 9 as proven, 34 as probable ), and 353 without IFI. In IFI group G test was positive in 31/43 cases, the positive rate was 72. 1% ; negative in 12/43 cases, false negative rate was 27. 9%. 48/353 cases of non-IFI group were positive, false positive rate was 13. 6%. The sensitivity, specificity, positive and negative predictive values were 72. 1%, 86.4%, 39.2% and 96. 2% respectively. According to ROC analysis, the AUC was 0. 815( 95% CI:0.732 -0. 898 ). Conclusions G test has good diagnostic value of IFI in children. Appropriately higher cutoffs or continuous monitoring may significantly control false positive rate of the test.%目的 评价血浆1,3-β-D葡聚糖(BG)检测(G试验)对儿童侵袭性真菌感染(IFI)的诊断价值.方法 回顾性分析2008年1月至2011年8月在首都医科大学附属北京儿童医院住院,抗生素应用时间>10 d,并行G试验患儿的临床资料,排除拟诊IFI者.根据IFI诊断标准,将研究对象分为IFI组和非IFI组.G试验测定采用GKT-5M Set动态真菌检测试剂盒,血浆BG浓度≥10 pg·mL-1判定G试验阳性.采用四格表计算G试验诊断IFI的敏感度、特异度、阳性预测值和阴性预测值.对G试验结果进行受试者特征工作曲线(ROC曲线)分析,并计算曲线下面积.结果 研究期间共有525例患儿行G试验,排除拟诊IFI者129例,最终396例患儿纳入分析.IFI组43例,非IFI组353例.IFI组G试验阳性31/43例,阳性率为72.1%;阴性12/43例,假阴性率为27.9%.非IFI组G试验阳性48/353例,假阳性率为13.6%.G试验诊断IFI的敏感度、特异度、阳性预测值和阴性预测值分别为72.1%、86.4%、39.2%和96.2%.根据G试验结果绘制ROC曲线,曲线下面积为0.815(95%CI:0.732～0.898).结论 G试验对儿童IFI具有中等诊断价值.适当提高诊断界值或连续监测可很大程度消除假阳性.