中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2015年
8期
672-676
,共5页
韩世权%苏晓蕾%赵睿%房开宇
韓世權%囌曉蕾%趙睿%房開宇
한세권%소효뢰%조예%방개우
(1,3)-β-D-葡聚糖检测%侵袭性真菌感染%白蛋白
(1,3)-β-D-葡聚糖檢測%侵襲性真菌感染%白蛋白
(1,3)-β-D-포취당검측%침습성진균감염%백단백
(1,3)-β-D-glucan test%Invasive fungal infection%Albumin
目的:探讨血浆(1,3)-β-D-葡聚糖检测(G试验)对侵袭性真菌感染(IFI)的诊断价值,及输注白蛋白对G试验的影响。方法采用前瞻性观察性研究方法,收集2012年1月21日至2014年10月31日大连市中心医院内科重症加强治疗病房(MICU)住院患者267例,根据IFI诊断标准将患者分为排除真菌感染组(35例)、拟诊组(70例)、临床诊断组(145例)、确诊组(17例)。使用MB-80微生物快速动态检测系统进行G试验检测。评估不同G试验临界值对IFI的诊断价值;比较G试验、真菌培养与临床诊断3种方法诊断IFI的差异;比较各组患者输注白蛋白前后G试验结果的变化,并评估输注白蛋白前后G试验对IFI的诊断价值。结果以20 ng/L为临界值,G试验诊断IFI的敏感度、特异度最高(分别为79.8%、87.9%),约登指数最大(为67.7%)。G试验、真菌培养与临床诊断IFI的阳性率分别为57.7%(154/267)、60.7%(162/267)与54.3%(145/267),两两比较差异均无统计学意义(均P>0.05)。与输注白蛋白前比较,排除真菌感染组、拟诊组、临床诊断组、确诊组输注白蛋白后G试验检测值(ng/L)均无明显改变(排除真菌感染组:11.25±2.33比10.99±1.07,t=-1.723,P=0.085;拟诊组:53.14±5.53比49.22±8.11,t=-0.395,P=0.693;临床诊断组:90.30±9.38比85.41±10.11,t=710.500,P=0.860;确诊组:100.98±19.24比103.21±17.66,t=653.000, P=0.449)。输注白蛋白前,G试验诊断IFI的敏感度、特异度、阳性预测值(PPV)、阴性预测值(NPV)及约登指数分别为79.8%、87.9%、45.6%、96.7%、67.7%,而输注白蛋白后分别为81.5%、85.7%、44.8%、96.5%、67.2%,与输注前较为一致。结论 G试验可作为早期诊断IFI有效的检测手段,以20 ng/L为临界值可获得较好的敏感度与特异度,输注白蛋白不影响G试验检测结果。
目的:探討血漿(1,3)-β-D-葡聚糖檢測(G試驗)對侵襲性真菌感染(IFI)的診斷價值,及輸註白蛋白對G試驗的影響。方法採用前瞻性觀察性研究方法,收集2012年1月21日至2014年10月31日大連市中心醫院內科重癥加彊治療病房(MICU)住院患者267例,根據IFI診斷標準將患者分為排除真菌感染組(35例)、擬診組(70例)、臨床診斷組(145例)、確診組(17例)。使用MB-80微生物快速動態檢測繫統進行G試驗檢測。評估不同G試驗臨界值對IFI的診斷價值;比較G試驗、真菌培養與臨床診斷3種方法診斷IFI的差異;比較各組患者輸註白蛋白前後G試驗結果的變化,併評估輸註白蛋白前後G試驗對IFI的診斷價值。結果以20 ng/L為臨界值,G試驗診斷IFI的敏感度、特異度最高(分彆為79.8%、87.9%),約登指數最大(為67.7%)。G試驗、真菌培養與臨床診斷IFI的暘性率分彆為57.7%(154/267)、60.7%(162/267)與54.3%(145/267),兩兩比較差異均無統計學意義(均P>0.05)。與輸註白蛋白前比較,排除真菌感染組、擬診組、臨床診斷組、確診組輸註白蛋白後G試驗檢測值(ng/L)均無明顯改變(排除真菌感染組:11.25±2.33比10.99±1.07,t=-1.723,P=0.085;擬診組:53.14±5.53比49.22±8.11,t=-0.395,P=0.693;臨床診斷組:90.30±9.38比85.41±10.11,t=710.500,P=0.860;確診組:100.98±19.24比103.21±17.66,t=653.000, P=0.449)。輸註白蛋白前,G試驗診斷IFI的敏感度、特異度、暘性預測值(PPV)、陰性預測值(NPV)及約登指數分彆為79.8%、87.9%、45.6%、96.7%、67.7%,而輸註白蛋白後分彆為81.5%、85.7%、44.8%、96.5%、67.2%,與輸註前較為一緻。結論 G試驗可作為早期診斷IFI有效的檢測手段,以20 ng/L為臨界值可穫得較好的敏感度與特異度,輸註白蛋白不影響G試驗檢測結果。
목적:탐토혈장(1,3)-β-D-포취당검측(G시험)대침습성진균감염(IFI)적진단개치,급수주백단백대G시험적영향。방법채용전첨성관찰성연구방법,수집2012년1월21일지2014년10월31일대련시중심의원내과중증가강치료병방(MICU)주원환자267례,근거IFI진단표준장환자분위배제진균감염조(35례)、의진조(70례)、림상진단조(145례)、학진조(17례)。사용MB-80미생물쾌속동태검측계통진행G시험검측。평고불동G시험림계치대IFI적진단개치;비교G시험、진균배양여림상진단3충방법진단IFI적차이;비교각조환자수주백단백전후G시험결과적변화,병평고수주백단백전후G시험대IFI적진단개치。결과이20 ng/L위림계치,G시험진단IFI적민감도、특이도최고(분별위79.8%、87.9%),약등지수최대(위67.7%)。G시험、진균배양여림상진단IFI적양성솔분별위57.7%(154/267)、60.7%(162/267)여54.3%(145/267),량량비교차이균무통계학의의(균P>0.05)。여수주백단백전비교,배제진균감염조、의진조、림상진단조、학진조수주백단백후G시험검측치(ng/L)균무명현개변(배제진균감염조:11.25±2.33비10.99±1.07,t=-1.723,P=0.085;의진조:53.14±5.53비49.22±8.11,t=-0.395,P=0.693;림상진단조:90.30±9.38비85.41±10.11,t=710.500,P=0.860;학진조:100.98±19.24비103.21±17.66,t=653.000, P=0.449)。수주백단백전,G시험진단IFI적민감도、특이도、양성예측치(PPV)、음성예측치(NPV)급약등지수분별위79.8%、87.9%、45.6%、96.7%、67.7%,이수주백단백후분별위81.5%、85.7%、44.8%、96.5%、67.2%,여수주전교위일치。결론 G시험가작위조기진단IFI유효적검측수단,이20 ng/L위림계치가획득교호적민감도여특이도,수주백단백불영향G시험검측결과。
ObjectiveTo explore the diagnostic value of plasma (1, 3)-β-D-glucan test (G test) in diagnosis of invasive fungal infections (IFI) and the influence of albumin on G test.Methods A prospective observational study was conducted. 267 patients admitted to medical intensive care unit (MICU) of Dalian Municipal Central Hospital from January 21st, 2012 to October 31st, 2014 were enrolled. According to IFI guideline, the patients were divided into without IFI group (n= 35), possible IFI group (n = 70), hypotheticle IFI group (n = 145) and proven IFI group (n = 17). G test was examined routinely using microbiology kinetic rapid reader MB-80.The different threshold values were calculated on G test. The difference among G tests, fungal culture and clinical diagnosis were compared. The results of G test ahead of and post albumin administration in each group were compared, and the value of G test for diagnosis of IFI during albumin infusion was evaluated.Results When the cut-off value was 20 ng/L for IFI diagnosis, higher sensitivity (79.8%), specificity (87.9%), and Youden index (67.7%) were found. The positive rates of G test, fungal culture and clinical diagnosis of IFI were 57.7% (154/267), 60.7% (162/267) and 54.3%(145/267) respectively, without showing significant differences (allP> 0.05). The result of G test (ng/L) was not obviously changed after albumin administration compared with that before in without IFI, possible IFI, hypotheticle IFI, and proven IFI groups (without IFI group: 11.25±2.33 vs. 10.99±1.07,t= -1.723,P= 0.085; possible IFI group: 53.14±5.53 vs. 49.22±8.11,t= -0.395,P= 0.693; hypotheticle IFI group: 90.30±9.38 vs. 85.41±10.11, t= 710.500,P= 0.860; proven IFI group: 100.98±19.24 vs. 103.21±17.66,t= 653.000,P= 0.449). Prior to the administration of albumin, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Youden index were 79.8%, 87.9%, 45.6%, 96.7%, 67.7%, respectively. However, after the administration of albumin, they were 81.5%, 85.7%, 44.8%, 96.5%, and 67.2%, respectively, without significant difference.Conclusions G test is method for early diagnosis of IFI. The sensitivity and specificity are higher with 20 ng/L as the critical value. The result of G test is not interfered by albumin administration.