血浆（1-3）-β-D葡聚糖检测和真菌培养在诊断深部真菌感染的临床价值

目的探讨血浆中（1—3）-β-D葡聚糖检测和真菌培养在诊断深部真菌感染的临床价值。方法对我院2008年4月至8月长期使用免疫抑制剂、皮质类固醇激素和／或广谱抗生素．且有感染体征的108例患者，在其发热当天抽静脉血做（1—3）-β-D葡聚糖检测，同时留取血液、呼吸道、泌尿道和肠道标本做真菌培养。通过回顾性调查．了解临床用药及患者是否症状缓解作为临床诊断标准．并以此为标准比较两者的差异。结果108例患者中使用抗真菌药物且症状缓解32例．使用抗真菌药物症状未缓解和未使用抗真菌药物并症状缓解76例。在108例患者中（1-3）-β-D葡聚糖含量检测阳性31例．阴性77例。108例真菌培养阳性59例，阴性49例。（1—3）-β-D葡聚糖含量检测与真菌培养结果对比差异显著酽=11．529，P〈0．01）；（1-3）-β-D葡聚糖含量检测与临床诊断对比差异不明显（X^2=0．0105，P〉0．05）；真菌培养与临床诊断比较差异显著（X^2=11．215，P〈0．01）。结论血浆（1—3）-β-D葡聚糖检测在诊断深部真菌感染方面的临床价值明显优于真菌培养。

Clinical value of plasma （1-3）-β-Dglucan detection and fungcal culture on the diagnosis of deep fungal infection

Objective To study clinical value of plasma （1-3）-β-D-glucan and fungal culture on the diagnosis of deep fungal infection. Methods 108 patients were phlebotomized to measure （1-3）-β-D-glucan from April to August, 2008. The samples peripheral blood, respiratory tract, urinary tract and intestinal canal were cultured from the patients with fever and therapy by immunosuppressant, corticosteroid hormone and wide-spectrum antibiotics for a long time. By retrospect investigation, we learnt clinical diagnosis and compare the difference between the two means. Results 31 patients of （1-3）-β-D-glucan test showed positive and 59 patients of fungal culture were positive; 32 fungal infection patients were positive in the 108 patients diagnosed by clinic. There were no difference between （1-3）-β-D-glucan test and clinical diagnosis （P〉0.05）; but showed significant differentces between（1-3）-β-D-glucan test and fungal culture, and between fungal culture and clinical diagnosis （P〈0.01）. Conclusions The clinical value of plasma （1-3）-β-D-glucan detection is superior to culture on the diagnosis of deep fungal infection.