CAJ | 학술논문

目的了解呼吸道分泌物真菌直接涂片检查的临床准确性.方法建立真菌直接涂片检查"7级法";对不同年龄段"无呼吸道炎症人群"(对照组)口咽部真菌的阳性概率及其数量进行调查;对临床呼吸道炎症患者痰液标本进行常规化真菌涂片检查;统计分析出院时确诊呼吸道真菌感染患者(病例组)的病历资料;列出四格表,计算其临床准确性.结果 "无呼吸道炎症人群"口咽部真菌直接涂片的阳性概率为0.008(5/622),其中≥50岁组为0.013(3/234)均为念珠菌,数量均为"少量".出院时确诊呼吸道真菌感染患者的"涂阳"率为0.418(301/720),其中≥50岁组为0.424(277/654).其临床准确性指标--灵敏度、特异度、阳性预测值、阴性预测值、准确度、尤登指数、阳性似然比、阴性似然比分别为0.418、0.992、0.984、0.596、0.684、0.410、52.25、0.587,≥50岁组分别为0.424、0.987、0.989、0.380、0.572、0.411、33.13、0.584;总体在≥50岁组的灵敏度和特异度之间,均P>0.50.结论痰液真菌直接涂片检查的灵敏度低而特异度高.排除误判的"涂阳",宜视为临床感染或亚临床隐性感染,不宜视为正常携带;若其数量大于"少量",则诊断意义更大;"涂阴"无否定意义.鉴于真菌感染患者中≥50岁组高达0.91(654/720),相关指标以≥50岁组者更具临床实用价值.
목적 료해호흡도분비물진균직접도편검사적림상준학성.방법 건립진균직접도편검사"7급법";대불동년령단"무호흡도염증인군"(대조조)구인부진균적양성개솔급기수량진행조사;대림상호흡도염증환자담액표본진행상규화진균도편검사;통계분석출원시학진호흡도진균감염환자(병례조)적병력자료;렬출사격표,계산기림상준학성.결과 "무호흡도염증인군"구인부진균직접도편적양성개솔위0.008(5/622),기중≥50세조위0.013(3/234)균위념주균,수량균위"소량".출원시학진호흡도진균감염환자적"도양"솔위0.418(301/720),기중≥50세조위0.424(277/654).기림상준학성지표--령민도、특이도、양성예측치、음성예측치、준학도、우등지수、양성사연비、음성사연비분별위0.418、0.992、0.984、0.596、0.684、0.410、52.25、0.587,≥50세조분별위0.424、0.987、0.989、0.380、0.572、0.411、33.13、0.584;총체재≥50세조적령민도화특이도지간,균P>0.50.결론 담액진균직접도편검사적령민도저이특이도고.배제오판적"도양",의시위림상감염혹아림상은성감염,불의시위정상휴대;약기수량대우"소량",칙진단의의경대;"도음"무부정의의.감우진균감염환자중≥50세조고체0.91(654/720),상관지표이≥50세조자경구림상실용개치.
Objective To investigate the clinical accuracy of directly smear test under microscope of fungus in respiratory system secretions.Methods We established the seven-level method of directly smear test under microscope of fungus. The positive probability and quantity of fungus were investigated on different aged subjects without respiratory inflammation (control group). The sputum samples of the patients with respiratory inflammation were measured with conventional smear test under microscope of fungus. The clinical data of definitely-diagnosed patients with respiratory fungal infection (case group) was statistically analyzed. The quadruple tabular form was made,and the clinical accuracy was estimated.Results The positive probability of directly smear test under microscope of fungus from the pharynx oralis was 0.008 (5/622) in control group,in which 0.013 (3/234) in ≥50 years old subgroup,and all detected fungi were candida and "little amount". The positive rate of smear test was 0.418 (301/720),in which 0.424 (277/654) in ≥50 years old subgroup. The clinical accuracy indices including sensitivity,specificity,positive predictive value,negative predictive value,accuracy,Youden′s index,positive likelihood ratio and negative likelihood ratio were 0.418,0.992,0.984,0.596,0.684,0.410,52.25 and 0.587,respectively in case group,and 0.424,0.987,0.989,0.380,0.572,0.411,33.13 and 0.584,respectively in ≥50 years old subgroup. There wasn′t statistical difference of sensitivity and specificity between control group or cases and their respective ≥50 years old subgroup (P>0.50).Conclusion The smear test of fungus in sputum is characteristic of low sensitivity and high specificity. When the misjudging "smear test positive results" were excluded,the smear test positive results might be an indication of clinical or subclinical infection. When the detected fungi were of larger number than "little amount",it hints definite clinical infection. The smear test positive result can′t exclude the fungal infection. Considering that the positive rate accounts for 0.91 (654/720) in ≥50 years old subgroup,the indices have more practical value in ≥50 years old subgroup.