葡聚糖与半乳甘露聚糖抗原联合检测对临床侵袭性真菌病的诊断价值
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摘要
目的探讨(1,3)-β-D-葡聚糖检测、半乳甘露聚糖抗原检测及(1,3)-β-D-葡聚糖与半乳甘露聚糖抗原联合检测对临床侵袭性真菌疾病的诊断价值。方法回顾性分析武汉市第一医院2014年7月～2016年7月临床疑诊为侵袭性真菌病的住院患者。根据2008年美国国立变态反应和感染病研究院真菌病研究组及欧洲癌症-侵袭性真菌感染治疗研究协作组修订的侵袭性真菌感染诊断标准[1],将患者分为IFI组(确诊、临床诊断)组与非IFI组(拟诊、排除真菌感染组)。分析G试验((1,3)-β-D-葡聚糖检测)、GM试验(半乳甘露聚糖抗原检测)及G试验与GM试验联合检测对IFI诊断的灵敏度、特异度、阳性预测值、阴性预测值;比较G试验、GM试验以及G试验与GM试验联合检测对IFI的诊断价值。结果在收集的250例患者中,IFI确诊患者10例,临床诊断患者100例,拟诊患者32例,排除真菌感染患者108例。G试验以>100pg/mL为阳性,对IFI诊断的灵敏度为74.5%,特异度为65.7%,阳性预测值为63%,阴性预测值为76.6%,约登指数为0.402;GM试验以I值≥0.5为试验阳性,对IFI诊断的灵敏度为50%,特异度为83.5%,阳性预测值为70.5%,阴性预测值为68%;G试验联合GM试验,对IFI诊断的灵敏度为90%,特异度为65%,阳性预测值为66.8%,阴性预测值为89.2%。G试验以≥100pg/mL为阳性,GM试验以I值≥0.5为阳性,G试验的ROC曲线下面积为0.712(95%置信区间为0.647～0.776);GM试验的ROC曲线下面积为0.666(95%置信区间为0.597～0.735)。结论 GM试验和G试验均对侵袭性真菌病具有诊断价值,是IFI可靠的诊断方法,G试验相比GM试验对临床侵袭性真菌病的诊断意义略强,二者联合应用可进一步提高应用价值。
Objective To explore the significance of(1,3)-β-D-glucan,galactomannan antigen and(1,3)-β-D-glucan Combined with galactomannan antigen tests in the diagnosis of invasive fungal diseases. Methods Patients suspected with invasive fungal infections were retrospectively analyzed from July 2014 to July 2016. According to the Diagnostic Criteria for Invasive Fungal Infections 2008 by US National Institute of Allergy and Infectious Fungal Disease,the patients were grouped into IFI group and non-IFI group. The sensitivity,specificity,positive and negative predictive values were analyzed by G-test,GM-test,and combined tests of both for IFI diagnosis. Results Among the 250 patients,10 patients were definitely diagnosed as IFI,100 patients were clinically diagnosed,32 patients were suspected,and fungal infection was excluded in 108 patients. The cut-off value of positive G-test was >100 pg/mL. The sensitivity,specificity,positive or negative predictive value and the Younger Index of the G-test were 74.5%,65.7%,63.6%,76.6%,and 0.402 respectively. When the cut-off value≥0.5 was taken as positive in GM-test,the above indexes were 50%,83.5%,70.5%,and 68%,respectively for the IFI diagnosis while when G-test combined with GM-test was used,the above indexes were increased. The area under ROC curve of GM-test was 0.666 whereas that of G-test was 0.712 if ≥100 pg/mL was used as positive threshold in G-test and≥0.5 in GM-test. Conclusion Both GM-and G-tests are reliable and combination of the two tests may improve the diagnosis of invasive fungal infections.
Objective To explore the significance of(1,3)-β-D-glucan,galactomannan antigen and(1,3)-β-D-glucan Combined with galactomannan antigen tests in the diagnosis of invasive fungal diseases. Methods Patients suspected with invasive fungal infections were retrospectively analyzed from July 2014 to July 2016. According to the Diagnostic Criteria for Invasive Fungal Infections 2008 by US National Institute of Allergy and Infectious Fungal Disease,the patients were grouped into IFI group and non-IFI group. The sensitivity,specificity,positive and negative predictive values were analyzed by G-test,GM-test,and combined tests of both for IFI diagnosis. Results Among the 250 patients,10 patients were definitely diagnosed as IFI,100 patients were clinically diagnosed,32 patients were suspected,and fungal infection was excluded in 108 patients. The cut-off value of positive G-test was >100 pg/mL. The sensitivity,specificity,positive or negative predictive value and the Younger Index of the G-test were 74.5%,65.7%,63.6%,76.6%,and 0.402 respectively. When the cut-off value≥0.5 was taken as positive in GM-test,the above indexes were 50%,83.5%,70.5%,and 68%,respectively for the IFI diagnosis while when G-test combined with GM-test was used,the above indexes were increased. The area under ROC curve of GM-test was 0.666 whereas that of G-test was 0.712 if ≥100 pg/mL was used as positive threshold in G-test and≥0.5 in GM-test. Conclusion Both GM-and G-tests are reliable and combination of the two tests may improve the diagnosis of invasive fungal infections.
引文
1 De Pauw B, Walsh T J, Donnelly J P, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group(EORTC/MSG)Consensus Group[J]. Clin Infect Dis, 2008, 46(12):1813-1821.
2袁炳斌,陈伟鹏,吕锐,等.ICU患者深部真菌感染的主要原因及预防措施[J].当代医学,2013, 19(28):97-98.
3曹楠楠.侵袭性真菌感染实验室早期诊断方法的现状与展望[J].国际检验医学杂志,2011, 32(7):781-783.
4赵红艳,张贺,姜美晨,等.(1, 3)-β-D葡聚糖检测在侵袭性真菌病诊断中的价值[J].中国临床研究,2013, 26(11):1233-1234.
5刘怡雯,詹,胡枫,等.ICU患者感染念珠菌的临床分布及体外药敏分析[J].中华医院感染学杂志,2016,26(20):4602-4604.
6申晓敏,李顺天.侵袭性曲霉菌病的实验室诊断[J].国际检验医学杂志,2015. 39(9):1270-1272.
7张静与瞿介明,肺曲霉病病谱及其诊断策略[J].中华结核和呼吸杂志,2015, 38(1):11-13.
8武宁,黄怡,李强,等.呼吸科重症加强治疗病房院内肺部真菌感染47例临床分析[J].中国呼吸与危重监护杂志,2008,7(3):182-186.
9 Shi X Y, Liu Y, Gu X M, et al. Diagnostic value of(1, 3)-β-D-glucan in bronchoalveolar lavage fluid for invasive fungal disease:A meta-analysis[J]. Respir Med, 2016, 117(5):48-53.
10王凡,韩志海,孟激光,等.血液病合并侵袭性真菌感染病原学及危险因素[J].中国感染控制杂志,2015,14(10):672-675.
11 De Waele J J, Vogelaers D, Blot S, et al. Fungal infections in patients with severe acute pancreatitis and the use of prophylactic therapy[J]. Clin Infect Dis,2003, 37(2):208-213.
12 Miyazaki T, Kohno S, Mitsutake K, et al. Plasma(1, 3)-beta-D-glucan and fungal antigenemia in patients with candidemia, aspergillosis, and cryptococcosis[J]. J Clin Microbiol, 1995, 33(12):3115-3118.
13黄云昆,史玉芹,祝雯梅,等。血浆(1, 3)-β-D葡聚糖检测对深部真菌感染诊断的临床评价[J].检验医学与临床,2013, 10(5):520-521.523.
14晏兰,宋微微,于强.血清降钙素原和半乳甘露聚糖水平变化与老年侵袭性曲霉菌感染的关系[J].南昌大学学报(医学版),2014, 54(04):63-66.
15 Mennink-Kersten, M A, J P. Donnelly and P E.Verweij, Detection of circulating galactomannan for thediagnosis and management of invasive aspergillosis[J].Lancet Infect Dis, 2004, 4(6):349-357.
2袁炳斌,陈伟鹏,吕锐,等.ICU患者深部真菌感染的主要原因及预防措施[J].当代医学,2013, 19(28):97-98.
3曹楠楠.侵袭性真菌感染实验室早期诊断方法的现状与展望[J].国际检验医学杂志,2011, 32(7):781-783.
4赵红艳,张贺,姜美晨,等.(1, 3)-β-D葡聚糖检测在侵袭性真菌病诊断中的价值[J].中国临床研究,2013, 26(11):1233-1234.
5刘怡雯,詹,胡枫,等.ICU患者感染念珠菌的临床分布及体外药敏分析[J].中华医院感染学杂志,2016,26(20):4602-4604.
6申晓敏,李顺天.侵袭性曲霉菌病的实验室诊断[J].国际检验医学杂志,2015. 39(9):1270-1272.
7张静与瞿介明,肺曲霉病病谱及其诊断策略[J].中华结核和呼吸杂志,2015, 38(1):11-13.
8武宁,黄怡,李强,等.呼吸科重症加强治疗病房院内肺部真菌感染47例临床分析[J].中国呼吸与危重监护杂志,2008,7(3):182-186.
9 Shi X Y, Liu Y, Gu X M, et al. Diagnostic value of(1, 3)-β-D-glucan in bronchoalveolar lavage fluid for invasive fungal disease:A meta-analysis[J]. Respir Med, 2016, 117(5):48-53.
10王凡,韩志海,孟激光,等.血液病合并侵袭性真菌感染病原学及危险因素[J].中国感染控制杂志,2015,14(10):672-675.
11 De Waele J J, Vogelaers D, Blot S, et al. Fungal infections in patients with severe acute pancreatitis and the use of prophylactic therapy[J]. Clin Infect Dis,2003, 37(2):208-213.
12 Miyazaki T, Kohno S, Mitsutake K, et al. Plasma(1, 3)-beta-D-glucan and fungal antigenemia in patients with candidemia, aspergillosis, and cryptococcosis[J]. J Clin Microbiol, 1995, 33(12):3115-3118.
13黄云昆,史玉芹,祝雯梅,等。血浆(1, 3)-β-D葡聚糖检测对深部真菌感染诊断的临床评价[J].检验医学与临床,2013, 10(5):520-521.523.
14晏兰,宋微微,于强.血清降钙素原和半乳甘露聚糖水平变化与老年侵袭性曲霉菌感染的关系[J].南昌大学学报(医学版),2014, 54(04):63-66.
15 Mennink-Kersten, M A, J P. Donnelly and P E.Verweij, Detection of circulating galactomannan for thediagnosis and management of invasive aspergillosis[J].Lancet Infect Dis, 2004, 4(6):349-357.