G试验联合GM试验对恶性血液病患者伴侵袭性真菌病的诊断价值研究

发布时间：2018-05-03 20:25

本文选题：( + )-β-D-葡聚糖　；参考：《中国微生态学杂志》2016年10期

【摘要】：目的探讨血浆(1,3)-β-D-葡聚糖检测(G试验)联合血浆半乳甘露聚糖检测(GM试验)对诊断恶性血液病患者伴侵袭性真菌病(IFD)的临床应用价值。方法收集安徽医科大学第一附属医院血液内科高危侵袭性真菌感染(IFI)病例193例,根据患者血浆G试验和GM试验的临床结果,分析其单项和联合检测时在IFD诊断中的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)。并同时分析GM试验结果在IFD患者治疗过程中的变化趋势。结果在血液肿瘤伴IFD的患者中,单独血浆G试验的检测敏感性、特异性、PPV和NPV分别是71.7%、89.3%、71.7%、89.3%。单独GM试验检测的敏感性、特异性、PPV和NPV分别是54.7%、94.3%、78.4%、84.6%。串联检测(两项同时阳性)的敏感性、特异性、PPV和NPV分别是39.6%、99.3%、95.5%、81.3%。并联检测(两项中任意一项阳性)的敏感性、特异性、PPV和NPV分别是86.6%、84.3%、67.7%、94.4%。17例GM试验阳性患者接受抗真菌治疗后,14例有效,3例无效。治疗有效组血浆GM值均从第2周开始下降,第3周降至正常水平,治疗无效组GM值持续升高,有效组和无效组差异有统计学意义(P0.05)。结论血浆G试验和血浆GM试验对恶性血液病患者伴IFD有较高的临床诊断价值,两者联合检测的临床诊断价值进一步提高,可作为IFI诊断的指标之一;动态监测GM值有利于评估临床抗真菌治疗的疗效。
[Abstract]:Objective to evaluate the clinical value of plasma T1D- 尾 -Dglucan test (GG test) and plasma galactomannan test (GM test) in the diagnosis of invasive mycosis (IFD) in patients with malignant hematopathy. Methods 193 cases of high risk invasive fungal infection in the Department of Hematology of the first affiliated Hospital of Anhui Medical University were collected. According to the clinical results of plasma G test and GM test, the sensitivity of the single and combined detection in the diagnosis of IFD was analyzed. Specificity, positive predictive value (PPVV), negative predictive value (NPV). At the same time, the change trend of GM test results in IFD patients was analyzed. Results in patients with hematologic tumor with IFD, the sensitivity, specificity and NPV of plasma G test were 71.7and 89.30.The sensitivity of plasma G test alone was 71.7 and 89.33.Results the sensitivity of plasma G test alone was 71.7% and the specificity of NPV was 71.7% and 89.33%, respectively. The sensitivity, specificity and NPV of GM test alone were 54.7% and 94.3%, 78.4% and 84.6%, respectively. The sensitivity, specificity and specificity of series test (both positive and positive) were 39.6 and 99.3 respectively. The sensitivity of parallel test (one of the two positive items), the specificity of PPV and NPV were 86.6 and 67.70.94. 4, respectively. There were 14 cases of effective and 3 cases of ineffective after anti-fungal therapy in 17 cases of GM test positive patients. In the effective group, the plasma GM value decreased from the second week to the normal level at the third week, and the GM value in the ineffective group continued to increase, and the difference between the effective group and the ineffective group was statistically significant (P 0.05). Conclusion Plasma G test and plasma GM test have a high clinical value in the diagnosis of IFD in patients with malignant hematologic diseases. The clinical diagnostic value of the combined detection of G test and GM test is further improved and can be used as one of the diagnostic indexes of IFI. Dynamic monitoring of GM value is helpful to evaluate the efficacy of antifungal therapy.
【作者单位】：安徽医科大学第一附属医院检验科;
【基金】：国家自然科学基金(81171618)
【分类号】：R733;R519

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