CAJ | 학술논문

目的：探讨呼吸道标本直接涂片和培养对曲霉菌诊断的价值。方法将85例呼吸道标本（痰液、肺泡灌洗液）培养曲霉菌阳性患者按曲霉菌感染及曲霉菌定植诊断标准分为曲霉菌感染组（30例）和曲霉菌定植组（55例）。均采用卡方检验和二分类 Logistic 回归分析细菌培养联合标本直接革兰染色对区别曲霉菌感染和定植的诊断意义。结果85例呼吸道合格标本曲霉菌培养和直接涂片阳性中，30例与临床诊断相符，符合率为35．2％。曲霉菌感染组镜下和培养检出正常菌群均显著低于定植组、曲霉菌检出次数显著高于定植组（均 P ＜0．05）。2组镜下WBC 浸润量、菌丝检出比较差异均无统计学意义（P ＝0．408，P ＝0．831）。经多因素 Logistic 回归分析示：曲霉菌检出次数、无正常菌群定植（包括镜下和培养均无正常菌群）对曲霉菌病诊断有统计学意义（P ＜0．05）；激素使用、糖尿病、呼吸衰竭及血液系统疾病是其疾病发生的主要影响因素。在曲霉菌培养阳性基础上，镜下未见正常菌群对诊断灵敏度为83．3％，阴性预测值均达83．9％，培养未见正常菌群诊断灵敏度为86．7％、阴性预测值为89．4％，但特异度和阳性预测值均低于60．0％；两者联合诊断曲霉菌感染的特异度可提高到66．4％，阳性预测值可为53．9％。三者联合检测（镜下和培养未见正常菌群与检出次数）能提高曲霉菌诊断的特异度（92．0％）和阳性预测值（71．0％）。结论在标本合格条件下曲霉菌检出阳性时，呼吸道标本直接涂片及培养出正常菌群对区分曲霉菌定植与感染具有诊断价值。
목적：탐토호흡도표본직접도편화배양대곡매균진단적개치。방법장85례호흡도표본（담액、폐포관세액）배양곡매균양성환자안곡매균감염급곡매균정식진단표준분위곡매균감염조（30례）화곡매균정식조（55례）。균채용잡방검험화이분류 Logistic 회귀분석세균배양연합표본직접혁란염색대구별곡매균감염화정식적진단의의。결과85례호흡도합격표본곡매균배양화직접도편양성중，30례여림상진단상부，부합솔위35．2％。곡매균감염조경하화배양검출정상균군균현저저우정식조、곡매균검출차수현저고우정식조（균 P ＜0．05）。2조경하WBC 침윤량、균사검출비교차이균무통계학의의（P ＝0．408，P ＝0．831）。경다인소 Logistic 회귀분석시：곡매균검출차수、무정상균군정식（포괄경하화배양균무정상균군）대곡매균병진단유통계학의의（P ＜0．05）；격소사용、당뇨병、호흡쇠갈급혈액계통질병시기질병발생적주요영향인소。재곡매균배양양성기출상，경하미견정상균군대진단령민도위83．3％，음성예측치균체83．9％，배양미견정상균군진단령민도위86．7％、음성예측치위89．4％，단특이도화양성예측치균저우60．0％；량자연합진단곡매균감염적특이도가제고도66．4％，양성예측치가위53．9％。삼자연합검측（경하화배양미견정상균군여검출차수）능제고곡매균진단적특이도（92．0％）화양성예측치（71．0％）。결론재표본합격조건하곡매균검출양성시，호흡도표본직접도편급배양출정상균군대구분곡매균정식여감염구유진단개치。
Objective To investigate the value of direct smear and culture of respiratory tract specimens in the diagnosis of aspergillosis.Methods Eighty-five patients with positive culture of Aspergillus from respiratory tract samples(sputum and bronchoalveolar lavage fluid)were divided into Aspergillus infection group(n=30)and Aspergillus colonization group(n=55).The diagnos-tic significance of direct gram stain in the differentiation of Aspergillus infection and colonization was analyzed using chi-square test and binary logistic regression.Results Among the 85 patients, direct smear and culture results were consistent with the clinical diagnosis in 30(35.2%).Com-pared with Aspergillus colonization group,normal flora detected by smear and culture significant-ly decreased but detection times obviously increased in Aspergillus infection group(P < 0.05). There were no significant differences in white blood cell infiltration and mycelium detection be-tween the two groups(P =0.408,P =0.831).Multiple logistic regression analysis showed that Aspergillus detection frequency and no normal flora colonization had statistical significance in the diagnosis of Aspergillosis(P <0.05).Hormone use,diabetes,respiratory failure and blood disea-ses were the major factors influencing the occurrence of aspergillosis.On the basis of culture posi-tive for Aspergillus,both microscopic examination and uncultured normal flora detection provided a sensitivity of 83.3%,86.7%,respectively,and a negative predictive value of 83.9%,89.4%,for Aspergillus infection,respectiely.However,both specificity and positive predictive value were less than 60.0%.The specificity and positive predictive value of the combined microscopy and uncul-tured normal flora detection were 66.4% and 53.9%,respectively.The specificity and positive predictive value of the combined microscopy,uncultured normal flora detection and cultured nor-mal flora detection were 92.0% and 71.0%,respectively.Conclusion When the detection of As-pergillus is positive under the condition of specimens meeting the standard,the direct smear and culture of respiratory tract specimens have diagnostic values in the differentiation of Aspergillus infection and colonization.