血清G试验在深部真菌感染中的诊断价值

目的 探讨血清1,3-β-D-葡聚糖含量测定(G试验)对深部真菌感染的诊断价值,为临床的早期诊断及个性化治疗提供可靠的依据。方法 收集2014年9月至2015年9月太和医院各临床科室高度怀疑深部真菌感染患者128例,同时进行血清G试验和真菌培养,采用统计学方法分析两种检验方法的差异。结果 血清G试验检测的阳性率57.81%(74/128)高于真菌培养阳性率46.88%(60/128),差异有统计学意义(P<0.05);真菌培养阳性患者血清中1,3-β-D-葡聚糖含量为(90.65±22.36)ng/L,健康对照者为(4.36±0.27)ng/L,差异有统计学意义(P<0.05)。采用真菌培养作为参考标准,G试验检测的敏感性、特异性、阳性预测值、阴性预测值分别为93.75%、78.30%、81.08%、92.59%。结论 血清G试验,方法简便、阳性率高、特异性高,可以辅助早期诊断深部真菌感染。     

G试验早期诊断深部真菌感染的临床价值

目的：分析 G 试验与体液真菌培养结果的相关性,探讨 G 试验在早期诊断深部真菌感染的临床价值。方法统计深圳市人民医院2009年10月-2010年12月进行 G 试验的住院患者887例,86例同时留取血液、脑脊液、胸腔或腹腔引流液等体液标本做真菌培养。观察 G 试验和真菌培养的符合率。结果在887例患者中 G 试验阳性标本146份,阳性率16.46％。标本阳性率居前三位的科室为老干部科、呼吸重症监护室、血液内科。在同时做体液真菌培养的86例患者中 G 试验阳性符合率80.00％;阴性符合率85.19％。结论 G 试验在早期诊断深部真菌感染有重要的临床价值。     

G试验对肺结核患者肺部真菌感染的早期诊断价值

目的 对肺结核疑似真菌感染患者血浆（1-3）-β-D-葡聚糖检测（G试验）和真菌培养结果进行比较,评估G试验对肺部真菌感染的早期诊断价值。方法 选取安徽省胸科医院2014年1月至2015年9月明确诊断为肺结核并且高度疑似真菌感染的患者60例,抽取静脉血分离血浆,检测（1-3）-β-D-葡聚糖含量;同时留取痰液行真菌培养加药敏检测,并进行统计学分析。结果 60例疑似肺部真菌感染的患者中,G试验检测阳性率为56.67%,痰真菌培养阳性率为51.67%,差异无统计学意义（χ²=0.07,P=0.30）。结论 G试验具有快速、早期、简便等特点,对肺结核合并侵袭性肺部真菌感染患者的早期诊断具有重要的临床意义。     

血浆(1-3)-β-D葡聚糖检测对深部真菌感染的诊断价值

<正>(1-3)-β-D葡聚糖是由D-葡聚糖合成的细胞壁多聚糖,占真菌细胞壁成分的50%以上[1]。研究表明,除结合菌外,所有真菌的细胞壁均含有(1-3)-β-D葡聚糖,而其他微生物、动物及人的细胞成分和细胞外液均不含有这种成分,因此在机体的体液或血液中检测(1-3)-β-D葡聚糖水平可以作为诊断深部真菌感染的依据[2]。本研究对98例疑似深部真菌感染患者血浆(1-3)-β-D葡聚糖含量进行检测,同时对患者痰标本进行培养,探讨血浆(1-3)-β-D葡聚糖检测对深部     

探究菌血症对G试验的干扰

目的了解菌血症对安度斯的真菌(1-3)-β-D葡聚糖检测试剂盒的干扰因素,有助于减少G试验的假阳性率。方法回顾分析48例非侵袭性真菌感染菌血症患者,血培养当日G试验检测结果。结果 48例非侵袭性真菌感染菌血症患者中18例(37.50%)为G试验阳性,其中革兰阳性菌感染的菌血症中11例G试验阳性(40.74%、11/27)均为葡萄球菌属感染。革兰阴性菌感染的菌血症中7例G试验阳性(33.33%、7/21),大肠埃希菌6例,铜绿假单胞菌感染1例。结果显示头状葡萄球菌,溶血葡萄球菌,人葡萄球菌,表皮葡萄球菌,金黄色葡萄球菌,大肠埃希菌,铜绿假单胞菌感染可引起G试验阳性。结论葡萄球菌属,大肠埃希菌,铜绿假单胞菌对湛江安度斯的真菌(1-3)-β-D葡聚糖检测试剂盒产生干扰,可引起G试验假阳性。     

血浆(1-3)-β-D葡聚糖检测的临床意义

目的:探讨深部真菌感染患者血浆(1-3)-β-D葡聚糖检测的临床意义.方法:应用MB-80微生物动态快速检测系统及真菌(1-3)-β-D检测试剂盒定量检测血浆中(1-3)-β-D葡聚糖的含量.结果:正常对照组血浆(1-3)-β-D葡聚糖含量为(2.79±2.46)pg/ml;深部真菌感染组为(49.05±31.13)pg/ml.经t检验,对照组与深部真菌感染组(1-3)-β-D葡聚糖平均值差异有非常显著性(t=6.843,P<0.001).结论:血浆葡聚糖检测可在拟诊早期为临床医生提供是否感染真菌的可靠信息,是一种实用的真菌感染早期诊断方法.     

老年肺真菌感染患者检测葡聚糖的临床意义

目的探讨检测葡聚糖对肺真菌感染老年患者的临床意义。方法真菌性肺部感染患者31例(A组)、混合性肺部感染(真菌+细菌)患者15例(B组)、细菌性肺感染患者35例(C组)、健康老年人35例(D组),应用MB-80微生物快速动态检测系统和真菌(1→3)-β-D葡聚糖检测试剂盒检测各组血浆(1→3)-β-D葡聚糖含量。结果 A组、B组、C组、D组血浆(1→3)-β-D葡聚糖含量分别为(56.23±11.77)pg/ml(、56.99±12.87)pg/ml(、8.39±2.12)pg/ml(、8.05±2.02)pg/ml。A组与B组比较、C组与D组比较无显著差异(P>0.05);A组(B组)与C组(D组)比较均有显著差异(P<0.01)。结论血浆(1→3)-β-D葡聚糖水平是早期诊断老年肺真菌感染患者的指标之一。     

血浆(1-3)-β-D-葡聚糖检测对临床侵袭性真菌感染诊断价值的研究

目的对临床疑似侵袭性真菌感染(IFI)患者进行血浆(1-3)-β-D-葡聚糖检测和真菌培养鉴定结果比较,评估血浆(1-3)-β-D-葡聚糖检测诊断IFI感染的实用价值。方法对疑似IFI感染患者131例抽取静脉血分离血浆,检测(1-3)-β-D-葡聚糖;于发热时采静脉血做真菌培养鉴定,并进行分析。结果 131例疑似IFI患者血浆(1-3)-β-D-葡聚糖阳性率为41.22%,真菌培养阳性率为37.40%。2种方法检测阳性率差异无统计学意义(P>0.05)。以真菌培养结果为参照,血浆(1-3)-β-D-葡聚糖检测敏感性为95.92,特异性为91.46,阳性预测值为87.04,阴性预测值为97.40。结论血浆(1-3)-β-D-葡聚糖检测具有较高的敏感性和特异性,对临床IFI的诊断具有实用价值。     

血液透析对血清(1→3)-β-D-葡聚糖浓度的影响

目的观察聚砜膜透析器透析对终末期肾脏病患者血清(1→3)-β-D-葡聚糖浓度的影响。方法选择维持性血液透析半年以上的终末期肾脏病患者58人,均采用聚砜膜透析器透析,分别在透析前以及透析结束后(临下机前5 min)抽外周静脉血,检测血清(1→3)-β-D-葡聚糖浓度,观察透析前后血清(1→3)-β-D-葡聚糖浓度的变化,并与健康对照组进行比较。结果患者透析前后血清(1→3)-β-D-葡聚糖浓度无明显变化,与健康对照组比较也无显著差异(P>0.05)。结论血液透析过程本身对血清(1→3)-β-D-葡聚糖浓度无影响,聚砜膜透析器透析不会导致血清(1→3)-β-D-葡聚糖检测的假阳性。     

(1,3)-β-D-葡聚糖合成酶小分子抑制剂研究进展

(1,3)-β-D-葡聚糖合成酶抑制剂通过破坏真菌细胞壁的合成而产生特异性的抗真菌作用。目前上市的(1,3)-β-D-葡聚糖合成酶抑制剂均为环六脂肽类,只能通过静脉注射给药。研发合成简便、可口服的(1,3)-β-D-葡聚糖合成酶小分子抑制剂具有巨大的研究前景。本文综述了近年来葡聚糖合成酶小分子抑制剂的研究进展。     

New investigational antifungal agents for treating invasive fungal infections

Systemic fungal infections have been recognised as a major cause of morbidity and mortality during the last two decades. There are only a few therapeutic options for these infections. Severe toxicity, such as impairment of renal function, limits the use of amphotericin B. Flucytosine is associated with side effects and drug resistance. Fluconazole and itraconazole are safer, though emergence of resistance and innate resistance in some fungal pathogens is a concern in their use. Therefore, there is a need for developing novel drugs and/or treatment strategies to combat these infections. In recent years, increased efforts by the pharmaceutical industry and academia have led to the discovery of new re-engineered or reconsidered antifungal agents that are more efficacious, safer and have a broad spectrum of activity. Lipid formulations of polyene antifungal agents, amphotericin B and nystatin, have the advantage of improved therapeutic index. Activity against resistant fungi, high bioavailability, safety and longer half-life are the properties that encourage development of the newer triazoles (e.g., voriconazole, ravuconazole and posaconazole). Echinocandin-like lipopeptide antibiotics are among the antifungal agents with a novel mode of action. In addition to these lead investigational compounds, development of newer antifungal agents is underway.     

Effect of natural polymers on the survival of Lactobacillus casei encapsulated in alginate microspheres

Linseed and okra mucilages, the fungal exopolysaccharide botryosphaeran, and commercial fructo-oligosaccharides (FOS) were used to microencapsulate Lactobacillus casei LC-01 and L. casei BGP 93 in sodium alginate microspheres by the extrusion technique in calcium chloride. The addition of carbohydrate biopolymers from linseed, okra and the fungal exocellular (1 → 3)(1 → 6)-β-D-glucan, named botryosphaeran provided higher encapsulation efficiency (EE) (>93% and >86%) for L. casei LC 01 and L. casei BGP 93, respectively. The use of linseed, okra and botryosphaeran improved the stability of probiotics encapsulated in the microspheres during the storage period over 15 d at 5?°C when compared to microspheres formulated with sodium alginate alone as the main encapsulating agent (p?≤?0.05). In in vitro gastrointestinal simulation tests, the use of FOS combined with linseed mucilage was shown to be more effective in protecting L. casei cells LC-01 and L. casei BGP 93.     

非血液标本1,3-β-D-葡聚糖检测对癌症患者放射治疗后真菌感染的诊断影响

目的:探究非血液标本1,3-β-D-葡聚糖(简称G试验)检测对癌症患者放射治疗后侵袭性真菌感染的诊断影响。方法:抽取2010年1月—2016年1月期间收治的非手术型癌症患者309例资料,筛选出放射后1周疑似真菌感染患者134例,最终被确诊为侵袭性肺部真菌感染患者41例;分析其的血液、气道分泌物、胸水G试验及真菌培养、鉴定结果,观察G试验及真菌培养检测对侵袭性真菌感染患者诊断的敏感度(sensitivity,SE)、特异度(specificity,SP)、阳性预测值(positive predicative value,PPV)、阴性预测值(negative predicative value,NPV)、准确度及Youden指数,并绘制ROC曲线。结果:检出真菌47株,其中念珠菌感染者34例、曲霉感染者4例和隐球菌感染者3例;在血液标本中,G试验高于真菌培养,特异度真菌培养高于G试验;在阳性预测值、阴性预测值以及准确度方面,G试验更为准确;在气道分泌物标本中,G试验高于真菌培养,特异度真菌培养高于G试验;在阳性预测值、阴性预测值以及准确度方面,G试验更为准确;在胸水标本中,G试验高于真菌培养,特异度真菌培养高于G试验;在阳性预测值、阴性预测值以及准确度方面,真菌培养更为准确;根据G试验结果显示,以10 pg/mL为界值,血液标本曲线下面积(AUC)为0.620(0.517,0.724);气道分泌物AUC为0.494(0.380,0.609);胸水AUC为0.385(0.284,0.487)。结论:对非手术治疗的肺癌患者放射治疗后的血液、气道分泌物及胸水采用G试验检测,结果表明非血液标本G试验检测对于真菌性感染的诊断具有较高诊断价值。     

The antifungal arsenal: alternative drugs and future targets

Clinically available antifungals for the treatment of invasive fungal infections primarily target either ergosterol in the fungal cell membrane or 1,3-β-D-glucan in the fungal cell wall. These classes include the polyene amphotericin B, the triazoles, and the echinocandins. Although newer antifungals and improved formulations of others have advanced our ability to treat patients with invasive mycoses, these drugs are often limited by toxicities, drug interactions, and the need for intravenous administration. Several investigational agents are currently under development. These include those that also target either ergosterol or 1,3-β-D-glucan, but have advantages over currently available drugs. Among these are the tetrazoles VT-1129, VT-1161, and VT-1598 that are more specific for fungal Cyp51 and less so for mammalian CYP 450 enzymes, the echinocandin CD101 that has an extended half-life, and the glucan synthase inhibitor SCY-078, which is being developed for oral administration. In addition, several agents with novel mechanisms of action are also under development. These include the inositol acyltransferase AX001, the dihydroorotate dehydrogenase inhibitor F901318, and VL-2397, which is similar in structure to the siderophore ferrichrome. In addition to possibly overcoming the limitations of currently available antifungals, these newer agents may be less susceptible to mechanisms of resistance that may render antifungals ineffective. Each of these investigational agents has the potential to improve patient outcomes in the treatment of invasive mycoses.     

296例医院内真菌感染分析

目的:了解住院患者深部真菌感染的发生情况.方法:采用回顾性分析方法,对我院2010年2 -12月间的真菌感染病例进行回顾性分析.结果:真菌感染296例;感染以念珠菌属为主,占90.54％,念珠菌属中感染占前三位的分别是白色念珠菌(54.73％)、热带念珠菌(13.18％)、光滑念珠菌(7.09％);真菌感染涉及的科室共有26个,其中,呼吸科感染例数居首,占33.78％;所有真菌感染病例均患有基础疾病,其中患肺部疾病的真菌感染率居首,占32.43％,肿瘤伴发的真菌感染死亡率最高,感染83例,死亡13例,死亡率为15.66％;在治疗上,应用的药物有氟康唑、卡泊芬净、伊曲康唑、伏立康唑、米卡芬净,其中氟康唑应用最频繁,达77.03％;真菌感染伴细菌感染的患者193例,占65.20％;大部分患者接受了侵入性操作.结论:对高龄、患严重基础疾病、需侵入性治疗的患者应采取适当的预防真菌感染的措施,合理选择药物,加强病原菌的监测,尤其对合并感染更要加强警惕,积极治疗,以减轻患者的痛苦.