血浆1-3-β-D葡聚糖检测联合真菌培养对深部真菌感染诊断的价值

目的探讨血浆中1-3-β-D葡聚糖(BG)检测(G试验)联合真菌培养对深部真菌感染诊断的临床应用价值。方法收集我院2012年1月²013年6月1010例住院患者资料,免疫比浊法检测1-3-β-D葡聚糖(G试验)含量,联合真菌培养结果,与临床诊断进行比对分析。结果 136例患者确诊为DFI,真菌培养阳性率为100%,G试验阳性率(>20μg/L)为92.65%。539例患者疑诊为DFI,真菌培养阳性率为66.23%,G试验阳性率为33.77%。335例患者排除诊断为DFI,真菌培养阳性率为0,G试验阳性率为0。1 010例怀疑DFI的患者中,G试验阳性患者为308例,包括确诊DFI和疑诊DFI患者,确诊DFI患者BG含量中位数,最小值和最大值均明显高于疑诊DFI患者BG含量。G试验阴性(<20μg/L)患者为702例,确诊DFI患者,疑诊DFI患者和排除诊断DFI患者BG含量差异无统计学意义(p>0.05)。结论 G试验联合真菌培养能用于准确确诊和排除诊断DFI,并且BG含量能反映诊断DFI的可靠程度。

VALUE OF PLASMA l-3-13-D GLUCAN ASSAY COMBINED WITH FUNGAL CULTURE IN DIAGNOSIS OF DEEP FUNGAL INFECTION

Objective To investigate the application for plasma 1 - 3 - β - D glucan （BG） assay （ G assay） combined with fungal culture for the diagnosis of deep fungal infection. Methods 1010 hospitalized cases from January of 2012 to June of 2013 in our hospital were collected. Plasma BG concentrations assessed by the dynamic turbidi- metric method combined with fungal culture were analyzed contracting clinical diagnosis. Results In 136 patients di- agnosed as DFI, positive rate of fungal culture was 100% and the positive rate of G - testing （ 〉 20 μg/L） was 92. 65%. In 539 patients with suspected DFI, positive rate of fungal culture was 66.23% , the positive rate of G - testing was 33.77%. In 335 patients excluded for the diagnosis of DFI, positive rate of fungal culture was 0, the positive rate of G - testing was O. In the 1 010 patients, 308 cases including DFI patients and suspected DFI patients were positive in G - testing and median value, minimum value and maximum value of BG concentration in I）FI pa- tients were significantly higher than those of suspected patients; 702 cases including DFI patients, suspected DFI pa- tients and patients excluded for the diagnosis of DFI were negative （ 〈 20 μg/L） in G - testing with no difference with statistical significance in BG concentration （p 〉 0. 05 ）. Conclusion G - testing combined with fungal culture can be utilized to accurately diagnose DFI and exclude the diagnosis of DFI and BG concentration can reflect the degree of re- liability for the diagnosis of DFI.