血浆(1,3)-β-D葡聚糖和血清半乳甘露聚糖检测对重症患者侵袭性真菌感染的早期诊断价值

摘要

目的 评价血浆(1,3)-β-D葡聚糖(BG)和血清半乳甘露聚糖(GM)联合检测对重症监护病房患者侵袭性真菌感染(IFI)的早期诊断价值.方法 收集昆明医科大学第一附属医院重症监护病房(ICU)中确诊为IFI的患者54例,疑诊10例和非真菌感染患者14例,同时收集健康成人血浆和血清各39份作为正常对照.分别采用比色法和ELISA法检测患者血浆BG值和血清GM,以G>100 ng/L为G试验阳性,以I值<1.0为GM试验阳性,计算G试验和GM试验及联合检测的灵敏度、特异度、阳性预测值(PPV)和阴性预测值(NPV).结果 G试验的灵敏度98.1%,特异度42.8%,阳性预测值86.9%,阴性预测值85.7%;GM试验灵敏度77.8%,特异度92.9%,阳性预测值97.7%,阴性预测值52.0%;G试验和GM试验联合检测的灵敏度98.1%,特异度98.9%,阳性预测值98.1%,阴性预测值98.9%.G试验和GM试验均与临床诊断差异有统计学意义(χ2=20.243,P<0.001;χ2=23.859,P<0.001).G试验的灵敏度和阴性预测值高于GM试验,差异有统计学意义(χ2=10.581,P=0.02),但GM试验特异度高于G试验,差异有统计学意义(χ2=8.023,P=0.013),而G试验和GM试验联合检测可同时提高敏感度和特异度.结论 G试验和GM试验联合检测,能明显减少试验假阴性和假阳性的发生,更有效地用于侵袭性真菌感染(IFI)的早期快速、准确诊断.%Objective To evaluate early diagnostic value of detecting plasma (1,3)-β-D glucans and serum Galactomannan of intensive care patients with invasive fungal infections.Methods Collected 54 patients confirmed IFI,10 cases suspected IFI and 14 cases of non-fungal infections in intensive care unit (ICU) and collected 39 healthy adults as normal controls in the First Affiliated Hospital of Kunming Medical University.Tested plasma BG and serum GM with colorimetry and ELISA.Calculated sensitivity,specificity,positive predictive value (PPV) ,negative predictive value (NPV) of G,GM test,joint detection under G-test positive of G>100 ng/L and GM-test positive of I value <1.0.Results The sensitivity,the specificity,the positive predictive value and the negative predictive value of G test were 98.1% ,42.8% ,86.9% and 85.7% respectively.The sensitivity,the specificity,the specificity,the positive predictive value and the positive predictive value of GM experiment were 77.8%,92.9%,97.7%, 52.0% respectively.The sensitivity, the specificity, the positive predictive value and the negative predictive value of the combined detection of G and GM were 98.1% ,98.9% ,98.1% and 98.9% respectively.The difference was statistically significant (χ2=20.243, P<0.001;χ2=23.859, P<0.001) compared G and GM test with clinical diagnosis.The sensitivity and the negative predictive value of G test was higher than GM test and the difference was statistically significant (χ2=10.581, P=0.02) , but the specificity of GM test was higher than that of G test and the difference was statistically significant (χ2=8.023 , P=0.013) , while the combined detection of G and GM could improve the sensitivity and specificity.Conclusion The joint detection of G and GM could significantly reduce the the experimental false negative and false positive occurrence for invasive fungal infections (IFI) early rapid and accurate diagnosis.