G试验联合GM试验诊断恶性血液病患者侵袭性真菌病的价值

摘要

目的 探讨血浆(1,3)-β-D-葡聚糖(G试验)联合血清半乳甘露聚糖抗原(GM试验)检测诊断恶性血液病患者侵袭性真菌病(IFD)的价值.方法 回顾性分析2016年1月至10月存在侵袭性真菌感染因素的304例住院患者的临床症状及真菌学指标.利用G试验ROC曲线,寻求G试验最适的诊断界值,结合GM试验,评价G试验及联合GM试验在IFD中的诊断灵敏度、特异性、阳性预测值和阴性预测值.结果 G试验≥150.55pg/ml时,灵敏度与特异性之和最大,AUC=0.803[(95％CI0.734-0.878),P<0.01];以G试验≥150.55pg/ml,GM≥0.5为界值,G试验、G试验串联GM试验和G试验并联GM试验诊断IFD灵敏度分别为66.67％、38.46％、82.05％;特异性分别为92.37％、98.20％、88.34％;阳性预测值为60.46％、78.94％、55.17％;阴性预测值为94.06％、90.12％、96.57％.结论 G试验联合GM试验并联能增加诊断的灵敏度和阴性预测值,串联能增加特异性和阳性预测值,两者联合应用,既能指导临床抗真菌治疗,又可以避免过度用药.%Objective To explore the application value of serum (1,3)-β-D-glucan and galactomannan for diagnosis of invasive fungal disease(IFD) in patients with hematological malignancies. Methods 304 hospitalized patients in the department of hemopathology of our hospital from January 2016 to October 2016 with high risk invasive fungal infections were enrolled. ROC curve of G test was used to seek the optimal diagnostic boundary value. The sensitivity,specificity,positive predictive value (PPV) and negative predictive value(NPV) of G test and the combination of GM test in the diagnosis of IFD were calculated. Results ROC curve analysis showed that the area under curve was 0.803(95％CI0.734-0.878),P<0.01,the diagnostic critical value was 150.55pg/ml. The sensitivity of G test,serial analysis of G and GM test and parallel analysis of G and GM test were 66.67％,38.46％,82.05％,respectively. The specificity were 92.37％,98.20％,88.34％,respectively. The PPV were 60.46％,78.94％,55.17％ and the NPV were 94.06％,90.12％,96.57％,respectively. Conclusions The parallel analysis of G and GM increase the sensitivity and the NPV and the serial analysis increase the specificity and the PPV in diagnosis of IFD. The combination of G and GM test can guide clinical preemptive antifungal treatment,and avoid excessive drug use.