血浆1,3-β-D葡聚糖检测联合念珠菌评分对侵袭性真菌感染的诊断价值

摘要

目的 探讨血浆1,3-β-D葡聚糖检测(G试验)和念珠菌评分(CS)对侵袭性真菌感染(IFI)的诊断价值.方法 收集2011年6月～2016年6月某院ICU科收治的201例IFI高危患者的病例,按照欧洲癌症研究治疗组及真菌研究组(EORTC/MSG)诊断标准,确诊9例,临床诊断73例,拟诊29例,非感染组90例,应用MB-80微生物动态快速检测系统及配套G试验试剂盒定量检测血浆中1,3-β-D葡聚糖的含量(1,3-β-D葡聚糖含量≥10 pg/mL为阳性),并对201例高危患者进行念珠菌评分(评分结果≥3为阳性),计算G试验与CS单独或联合使用敏感度、特异度、阳性预测值、阴性预测值.结果 IFI感染部位以呼吸道最常见,致病菌以白念珠菌为主.血浆1,3-β-D葡聚糖检测阳性者有88例,念珠菌评分阳性者有85例.联合使用血浆1,3-β-D葡聚糖检测与念珠菌评分,其灵敏度、特异度、阳性预测值、阴性预测值分别为:95.1％、71.1％、75.0％、94.1％;相比血浆1,3-β-D葡聚糖检测与念珠菌评分单独使用,其灵敏度、阴性预测值最高,特异度、阳性预测值相近.结论 血浆1,3-β-D葡聚糖检测与念珠菌评分联合应用时,灵敏度及阴性预测值均较单独使用增高,联合应用对诊断侵袭性真菌感染意义更大.%Objective To discuss the diagnostic value of plasma 1,3-β-D-glucan (G test) and Candida score (CS) to invasive fungal infection (IFI).Method Collecting clinical information of 201 patients with high risk of invasive Candida infection treated in the ICU of someone hospital from June 2011 to June 2016,according to diagnostic criteria of European cancer research and treatment group and fungal research group (EORTC/MSG),9 cases as proven were diagnosed as proven,73 cases as probable,29 cases as possible,90 cases as non-invasive infection.Microbiology Kinetic Rapid Reader MB-80 was used to measure the concentration of plasma 1,3-β-D-glucan (exceed 10pg/mL is regarded as positive),and Candida score was utilized in those patients (exceed 3 scores is regarded as positive),then to calculate the sensitivity,specificity,positive predictive value,negative predictive values for G test and Candida score used exclusively or jointly.Result Respiratory tract was the most probable infected site,and Candida albicans was the main pathogenic fungi.In all patients 88 cases was positive by G test,85 cases is positive by Candida score.Plasma 1,3-β-D-glucan and Candida score were used jointly,whose sensitivity,specificity,positive predictive value,and negative predictive values were 95.1％,71.1 ％,75.0 ％,94.1 ％;compared with plasma 1,3-β-D-glucan and Candida score used exclusively,whose sensitivity and negative predictive value were the highest,specificity and positive predictive value were approximate among them.Conclusion When plasma 1,3-[β-D-glucan and Candida score were used jointly,sensitivity and negative predictive value were higher than that were used alone,plasma 1,3-β-D-glucan combined with Candida score had more significant diagnostic value.