1,3-β-D葡聚糖和半乳甘露聚糖检测对ICU患者侵袭性真菌感染的诊断价值

摘要

目的 评价1,3-β-D葡聚糖(BG)和半乳甘露聚糖(GM)检测对重症监护室(ICU)患者侵袭性真菌感染(IFI)的早期诊断价值.方法 于2013-2015年,对452例ICU高危IFI患者(临床诊断IFI 182例,拟诊IFI 46例,排除IFI 224例),进行血清BG和GM检测,结合临床诊断,分析BG和GM检测,以及二者联合检测对IFI的诊断特异度、灵敏度、阳性预测值(PPV)和阴性预测值(NPV).结果 BG检测对IFI的诊断灵敏度为75.0%,特异度为80.4%,PPV为75.8%,NPV为79.6%;GM检测的诊断灵敏度为25.8%,特异度为85.7%,PPV为59.5%,NPV为58.7%;二者联合检测的诊断灵敏度为87.4%,特异度为94.7%.结论 BG联合GM检测可提高对IFI的诊断效能,降低假阳性率和假阴性率,为ICU患者IFI早期诊治提供一定的依据.%Objective To evaluate the early diagnostic value of 1,3-β-D glucan(BG) and galactomannan(GM) test for invasive fungal infections(IFI)in intensive care unit(ICU) patients.Methods From 2013 to 2015,the concentration of serum BG and GM were detected in 452 cases of ICU patients,including 182 cases with diagnosis of IFI,46 cases with possible diagnosis of IFI and 224 cases of non-IFI.The diagnostic performance of BG,GM and combined test were analyzed.Results The sensitivity,specificity,positive predictive value(PPV) and negative predictive value(NPV)of BG test were 75.0%,80.4%,75.8%,79.6%.Those of GM test were 25.80%,85.7%,59.5% and 58.7%.The sensitivity and specificity of BG and GM combined test were 87.4% and 94.7% respectively.Conclusion BG and GM combined test could improve the diagnostic efficiency,reduce the false positive rate and false negative rete,which might be helpful for the early diagnosis of IFI in ICU patients.