血浆(1,3)-β-D葡聚糖检测对器官移植患者侵袭性真菌感染诊断价值

摘要

目的 探讨血浆(1,3)-β-D葡聚糖(BG)检测(G试验)在诊断器官移植术后合并侵袭性真菌感染(IFI)的诊断价值.方法 回顾性分析2011年1月～2012年12月130例在本院肝、肾移植中心住院疑似IFI的患者的血浆标本,进行G实验检测.其中64例最终确诊或临床诊断为IFI患者,设为IFI组,余66例为非IFI组.应用MB-80微生物动态快速检测系统和GKT-5M Set动态真菌检测试剂盒,血浆BG浓度≥10 pg/mL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 130例患者中,IFI组中G试验阳性57/64,阳性率89.1％;阴性7例,假阴性率10.9％.非IFI组G试验阳性15/66,假阳性率22.7％.G试验阳性诊断IFI的敏感度、特异度、阳性预值和阴性预测值分别为89.1％,77.3％,79.2％和87.9％.根据G试验结果绘制ROC曲线,曲线下面积为0.875(95％ CI:0.813～0.937).结论 G试验对器官移植患者IFI具有中等诊断价值.适当提高诊断界值及重复检测可较大程度地消除假阳性.%Objective To evaluate the diagnostic value of plasma 1,3-β-D glucan (BG) assay (G test) to invasive fungal infection (IFI) in organ transplant recipients.Methods By retrospectively accessing the clinical data of pediatric inpatients who underwent G test.The patients being recruited from January 2011 to December 2012 were split into two groups:group IFI comprised 64 patients with proven and probable IFI.Group control comprised 66 patients without fungal infection.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.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 In IFI group G test was positive in 57 cases,the positive rate was 89.06％.15 cases of non-IFI group were positive,false positive rate was 22.7％.The G test sensitivity,specificity,positive and negative predictive values were89.1％,77.3％,79.2％ and 87.9％ respectively.According to ROC analysis,the AUC was 0.875 (95 ％ CI:0.813 ～ 0.937).Conclusions G test has good diagnostic value of IFI in organ transplant patients.Appropriately higher cutoffs or continuous monitoring may significantly control false positive rate of the test.