(1,3)-β-D葡聚糖、半乳甘露聚糖联合降钙素原检测对侵袭性真菌感染的诊断价值

目的 探讨血清中(1,3)-β-D葡聚糖 (1,3) β-D-glucan,G]和半乳甘露聚糖(galactomannan,GM)联合降钙素原(procalcitonin,PCT)检测对患者侵袭性真菌感染(invasive fungal infections,IFI)的临床诊断价值。方法 选取徐州市中心医院2017年1月至2018年6月收治的具有高危IFI因素的住院患者447例,根据血培养结果分成实验室诊断组和非实验室诊断组。分别采用定量检测、比色法及电化学发光法对血清中G、GM和PCT的含量进行检测,评价三者联合检测对IFI的早期诊断价值。结果 447例患者中实验室诊断组51例,非实验室诊断组396例。51例患者中G试验阳性39例,GM试验阳性14例,PCT阳性41例。G试验、GM试验、PCT检测的敏感性为76.47%、27.45%和80.39%;特异性为76.77%、87.12%和66.67%;阳性预测值为29.77%、21.54%和23.70%;阴性预测值为96.20%、90.31%和96.35%;阳性似然比为3.29、2.13和2.41;阴性似然比为0.31、0.83和0.29;Youden指数为0.53、0.15、0.47。三者联合检测的敏感性为94.12%、特异性为62.88%、阳性预测值为24.62%,阴性预测值为98.81%,阳性似然比为2.54,阴性似然比为0.09,Youden指数为0.57。三者联合检测的敏感性均高于G试验、GM试验、PCT单独检测及G/GM联合试验,差异具有统计学意义(χ2值分别为6.331、47.545、4.320和5.299,P值均<0.05)。三者联合检测的特异性均低于G试验、GM试验单独检测及G/GM联合试验,差异具有统计学意义(χ2值分别为18.127、62.061和16.754,P值均<0.05),但与PCT单独检测相比差异无统计学意义(χ2=1.245,P>0.05)。结论 G、GM以及PCT三者联合检测可显著提高IFI检出的敏感性,并且对IFI的诊断排除有很大的价值,从而降低假阳性率和假阴性率,为IFI的早期诊断提供一定的依据。

Diagnosis value of combining(1,3)-β-D-glucan,aspergillus galactomannan and procalcitonin for invasive fungal infection

Objective To evaluate the detection value of serum(1,3)β-D-glucan(G),galactomannan(GM)and procalcitonin quantitative detection(PCT)in clinical diagnosis of invasive fungal infections(IFI).Methods Total of 447 patients with high-risk invasive fungal infection were selected from Xuzhou Central Hospital.According to the results of blood culture,they were divided into laboratory diagnosis group and non laboratory diagnosis group.Quantitative detection,colorimetry and electrochemiluminescence were used to detect the contents of G,GM and PCT in serum,respectively.The combined detection of the three methods was evaluated for the early diagnosis of IFI.Results Among the 447 patients,51 were in the laboratory diagnosis group and 396 in the non laboratory diagnosis group.There were 39 patients in G test,14 patients in GM test and 41 patients in PCT test showed positive in the non laboratory diagnosis group.The sensitivity of G test,GM test,and PCT test was 76.47%,27.45%and 80.39%respectively,the specificity was 76.77%,87.12%and 66.67%respectively,the positive predictive values were 29.77%,21.54%and 23.70%respectively,the negative predictive values were 96.20%,90.31%,96.35%respectively,the positive likelihood ratios were 3.29,2.13 and 2.41 respectively,the negative likelihood ratios were 0.31,0.83 and 0.29 respectively,and the Youden index was 0.53,0.15 and 0.47 respectively.When combined the three tests detection,the sensitivity was 94.12%,the specificity was 62.88%,the positive predictive value was 24.62%,the negative predictive value was 98.81%,the positive likelihood ratio was 2.54,the negative likelihood ratio was 0.09,and the Youden index was 0.57.The sensitivity of the three combined tests was significantly higher than that of the G test,GM test,PCT alone test and G/GM combined test(χ2 values were 6.331,47.545,4.320,and 5.299 respectively,all P values were<0.05).The specificity of the three combined tests is significantly lower than that of the G test,the GM test alone and the G/GM combined test(χ2 values are 18.127,62.061 and 16.754 respectively,all P values were<0.05),but the difference was not statistically significant compared with PCT alone(χ2=1.245,P>0.05).Conclusion The combination of G-test,GM-tests and PCT can improve the sensitivity of early diagnosis of IFI patients.Combined detection of the three can reduce false positive and false negative,and guide the clinicians in the early treatment of IFI.