CAJ | 학술논문

目的探讨外周血半乳甘露聚糖(GM试验)联合1,3-β-D葡聚糖(G试验)在侵袭性真菌感染(IFI)诊断中的应用价值.方法选择2012年9月至2013年11月浙江省中医院261例恶性血液病患者,其中IFI确诊1例,临床诊断24例,临床拟诊50例,排除诊断186例.运用酶联免疫吸附试验(ELISA)和动态试管比浊法检测所有患者血清半乳甘露聚糖和血浆1,3-β-D葡聚糖的浓度.观察患者治疗前后曲霉抗原指数和1,3-β-D葡聚糖变化情况.采用x2检验比较GM和G试验单独及联合使用诊断IFI的灵敏度、特异度、阴性预测值和阳性预测值.结果 261例患者中,GM试验阳性57例,G试验阳性73例.GM试验诊断IFI的灵敏度、特异度、阴性预测值和阳性预测值分别为92.0％,97.3％,82.1％和98.9％;G试验分别为96.0％,89.8％,55.8％和99.4％;GM和G试验联合检测分别为92.0％,97.8％,85.2％和99.4％,其中特异性和阳性预测值明显高于G试验(x2=10.399和6.393,P＜0.05).氟立康唑治疗有效者的曲霉抗原指数和1,3-β-D葡聚糖血浆浓度较治疗前显著下降.结论 GM和G试验可辅助诊断IFI,两者联合使用可增加特异性,其结果变化可反映真菌治疗效果.
목적 탐토외주혈반유감로취당(GM시험)연합1,3-β-D포취당(G시험)재침습성진균감염(IFI)진단중적응용개치.방법 선택2012년9월지2013년11월절강성중의원261례악성혈액병환자,기중IFI학진1례,림상진단24례,림상의진50례,배제진단186례.운용매련면역흡부시험(ELISA)화동태시관비탁법검측소유환자혈청반유감로취당화혈장1,3-β-D포취당적농도.관찰환자치료전후곡매항원지수화1,3-β-D포취당변화정황.채용x2검험비교GM화G시험단독급연합사용진단IFI적령민도、특이도、음성예측치화양성예측치.결과 261례환자중,GM시험양성57례,G시험양성73례.GM시험진단IFI적령민도、특이도、음성예측치화양성예측치분별위92.0％,97.3％,82.1％화98.9％;G시험분별위96.0％,89.8％,55.8％화99.4％;GM화G시험연합검측분별위92.0％,97.8％,85.2％화99.4％,기중특이성화양성예측치명현고우G시험(x2=10.399화6.393,P＜0.05).불립강서치료유효자적곡매항원지수화1,3-β-D포취당혈장농도교치료전현저하강.결론 GM화G시험가보조진단IFI,량자연합사용가증가특이성,기결과변화가반영진균치료효과.
Objective To evaluate the combination of serum galactomannan test (GM test) with plasma 1,3-β-D-glucan test (G test) in diagnosis of invasive fungal infections (IFI).Methods A total of 261 patients with hematologic malignancies admitted in Zhejiang Provincial Hospital of Traditional Chinese Medicine from September 2012 to November 2013 were enrolled,including 1 patient with confirmed IFI,24 with clinically diagnosed IFI,50 with suspended IFI and 186 patients with excluded IFI.Serum galactomannan and plasma 1,3-β-D-glucan were detected with enzyme-linked immunosorbent assay (ELISA) and dynamic turbidimetric assay,respectively.Changes on aspergillus galactomannan antigen and 1,3-β-D glucan concentrations before and after treatment were observed.And chi-square test was used to compare sensitivities,specificities,negative predictive values and positive predictive values of GM test and G test and the combination of GM and G tests in diagnosing IFI.Results Within 261 patients,57 were positive in GM test,and 73 were positive in G test.The sensitivity,specificity,negative predictive value and positive predictive value of GM test were 92.0％,97.3％,82.1％ and 98.9％ ; Those of G test were 96.0％,89.8％,55.8％ and 99.4％ ; And those of GM combined with G test were 92.0％,97.8％,85.2％ and 99.4％.Compared with G test,the specificity and positive predictive value were higher when GM combined with G test (x2 =10.399 and 6.393,P ＜ 0.05).In those who responded to voriconazole treatment,serum GM test and plasma M test showed a decreased value after the treatment.C.onclusions GM and G tests are of value in diagnosis of IFI,and the combination of GM and G tests can improve the diagnostic specificity.Dynamic change of GM and G test values can reflect the therapeutic response.