安徽医药
安徽醫藥
안휘의약
ANHUI MEDICAL AND PHARMACEUTICAL JOURNAL
2015年
4期
686-689,690
,共5页
沈勇%刘宝%翁云龙%肖齐俊%黄鑫
瀋勇%劉寶%翁雲龍%肖齊俊%黃鑫
침용%류보%옹운룡%초제준%황흠
支气管肺泡灌洗液(BALF)%(1,3)-β-D葡聚糖(BG)%侵袭性肺真菌感染(IPFI)
支氣管肺泡灌洗液(BALF)%(1,3)-β-D葡聚糖(BG)%侵襲性肺真菌感染(IPFI)
지기관폐포관세액(BALF)%(1,3)-β-D포취당(BG)%침습성폐진균감염(IPFI)
bronchoalveolar lavage fluid (BALF)%(1,3)-β-D-glucan(BG)%invasive pulmonary fungal infections(IPFI)
目的：探讨支气管肺泡灌洗液（BALF）中的（1，3）-β-D葡聚糖（BG）检测对早期诊断侵袭性肺真菌感染（IPFI）的价值。方法（1）选择2011年6月至2013年12月六安市人民医院收治的172例患者，其中确诊IPFI组、普通感染组和无肺部感染组各32例，共96例，此外入院时有真菌感染的高危因素但早期未确诊IPFI者76例作进一步研究，每日连续真菌检测直至明确是否为IPFI，进而分诊断组、排除组。全部对象均予支气管肺泡灌洗，留取BALF及血浆进行G试验（ BG抗原检测），对数据采用独立样本秩和检验来检验并绘制受试者工作ROC曲线，确定两种标本检测方法诊断IPFI的最佳临界值。结果（1） BALF G试验水平：IPFI组明显高于单纯肺炎组和非感染组。（2）76例未确诊病例在随后的5 d检查中7例确诊IPFI，22例临床诊断，29例剔除，18例排除真菌感染。（3）诊断组BALF、血浆BG水平均显著高于排除组，BALF BG浓度为149．5 ng· L－1时对应的约登指数值最大，为0．87，血浆BG浓度为81 ng· L－1时对应的约登指数值最大，为0．81。（4）诊断组BALF BG峰值浓度出现时间早于血浆，同时诊断的特异性高于血浆。结论（1） BALF中BG的含量较血浆中升高更明显，且BALF G试验在区分单纯肺炎和IPFI方面更具有参考价值。（2） BALF G试验特异度、敏感度均明显高于血浆G试验，且峰值出现早于血浆，具有更早、更准确、更高的临床诊断价值。（3）BALF G试验的最佳诊断临界值是149．5 ng· L－1，其诊断IPFI的特异性和敏感性均较高。
目的：探討支氣管肺泡灌洗液（BALF）中的（1，3）-β-D葡聚糖（BG）檢測對早期診斷侵襲性肺真菌感染（IPFI）的價值。方法（1）選擇2011年6月至2013年12月六安市人民醫院收治的172例患者，其中確診IPFI組、普通感染組和無肺部感染組各32例，共96例，此外入院時有真菌感染的高危因素但早期未確診IPFI者76例作進一步研究，每日連續真菌檢測直至明確是否為IPFI，進而分診斷組、排除組。全部對象均予支氣管肺泡灌洗，留取BALF及血漿進行G試驗（ BG抗原檢測），對數據採用獨立樣本秩和檢驗來檢驗併繪製受試者工作ROC麯線，確定兩種標本檢測方法診斷IPFI的最佳臨界值。結果（1） BALF G試驗水平：IPFI組明顯高于單純肺炎組和非感染組。（2）76例未確診病例在隨後的5 d檢查中7例確診IPFI，22例臨床診斷，29例剔除，18例排除真菌感染。（3）診斷組BALF、血漿BG水平均顯著高于排除組，BALF BG濃度為149．5 ng· L－1時對應的約登指數值最大，為0．87，血漿BG濃度為81 ng· L－1時對應的約登指數值最大，為0．81。（4）診斷組BALF BG峰值濃度齣現時間早于血漿，同時診斷的特異性高于血漿。結論（1） BALF中BG的含量較血漿中升高更明顯，且BALF G試驗在區分單純肺炎和IPFI方麵更具有參攷價值。（2） BALF G試驗特異度、敏感度均明顯高于血漿G試驗，且峰值齣現早于血漿，具有更早、更準確、更高的臨床診斷價值。（3）BALF G試驗的最佳診斷臨界值是149．5 ng· L－1，其診斷IPFI的特異性和敏感性均較高。
목적：탐토지기관폐포관세액（BALF）중적（1，3）-β-D포취당（BG）검측대조기진단침습성폐진균감염（IPFI）적개치。방법（1）선택2011년6월지2013년12월륙안시인민의원수치적172례환자，기중학진IPFI조、보통감염조화무폐부감염조각32례，공96례，차외입원시유진균감염적고위인소단조기미학진IPFI자76례작진일보연구，매일련속진균검측직지명학시부위IPFI，진이분진단조、배제조。전부대상균여지기관폐포관세，류취BALF급혈장진행G시험（ BG항원검측），대수거채용독립양본질화검험래검험병회제수시자공작ROC곡선，학정량충표본검측방법진단IPFI적최가림계치。결과（1） BALF G시험수평：IPFI조명현고우단순폐염조화비감염조。（2）76례미학진병례재수후적5 d검사중7례학진IPFI，22례림상진단，29례척제，18례배제진균감염。（3）진단조BALF、혈장BG수평균현저고우배제조，BALF BG농도위149．5 ng· L－1시대응적약등지수치최대，위0．87，혈장BG농도위81 ng· L－1시대응적약등지수치최대，위0．81。（4）진단조BALF BG봉치농도출현시간조우혈장，동시진단적특이성고우혈장。결론（1） BALF중BG적함량교혈장중승고경명현，차BALF G시험재구분단순폐염화IPFI방면경구유삼고개치。（2） BALF G시험특이도、민감도균명현고우혈장G시험，차봉치출현조우혈장，구유경조、경준학、경고적림상진단개치。（3）BALF G시험적최가진단림계치시149．5 ng· L－1，기진단IPFI적특이성화민감성균교고。
Objective To explore the test value of (1,3)-β-D-glucan in BALF in the early diagnosis of invasive pulmonary fungal in-fections(IPFI).Methods We selected 172 patients admitted to the Lu’an Hospital from June 2011 to December 2013,32 patients of which enrolled in the confirmed IPFI group,32 patients in pneumonia infection group,and 32 patients in non-infection group.Another 76 patients who had high risk factors of fungi infection but no evidence of confirmed IPFI when they were charged in hospital were stud-ied further.They were detected every day to determine whether they had fungal infection before assigned into either confirmed group or non-infection group.All patients underwent BAL and took G test of BALF and plasma.The data were analyzed statistically by independ-ent samples rank sum test and the receiver operating characteristics ( ROC) curve was established to derive the best threshold of the 2 G tests.Results As for G test of BALF,the mean of IPFI group was significantly higher than pneumonia infection group and non-infec-tion group.Of the 76 cases,7 cases were confirmed as IPFI in the subsequent 5-day examination,22 cases clinically diagnosed,29 cases excluded and 18 cases enrolled in non-infection group.ROC area under the curve of G test of BALF for the diagnosis of IPFI was 0.87, and the best threshold was 149.5 ng· L-1 ,while those for G test of plasma was 0.81 and 81 ng· L-1 .The maximum concentration of (1,3)-β-D-glucan of BALF came earlier than the plasma and the specificity was higher.Conclusions BG in BALF is significantly higher than that in plasma and G test of BALF may be more advantageous over plasma in distinguishing between simple pneumonia and IPFI.The sensitivity and specificity of G test of BALF are higher than those of plasma,which has earlier peak value and more accurate and higher clinical value.The best threshold of G test of BALF for the diagnosis of IPFI is 149.5 ng· L-1 ,whose sensitivity and speci-ficity in diagnosis of IPFI is higher.
