血浆1，3-β-D葡聚糖检测对诊断侵袭性深部真菌感染的临床价值

发布时间：2018-07-04 18:47

本文选题：1 + 3-β-D-葡聚糖　；参考：《新疆医科大学》2013年硕士论文

【摘要】：目的：评价血浆1，3-β-D葡聚糖检测对早期诊断临床侵袭性深部真菌感染(IFI)的价值。方法：回顾性分析2011年6月至2012年11月期间收住新疆医科大学第一附属医学院呼吸内科、呼吸重症监护室和感染科的满足以下入选标准：（1）根据中国IFI工作组制定的《血液病／恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则(第三次修订)》标准，明确诊断IFI的患者或是临床诊断IFI的患者；（2）在接受抗真菌药物治疗前已完善血浆G实验和（或）GM实验的患者，，共66例。同时在所有的住院患者中，根据IFI组的66位患者的年龄、性别、基础疾病分别配对，此66位非IFI患者,设为对照组。应用MB-80微生物快速动态监测系统及GKT-1M Set动态真菌检测试剂盒血浆检测(l，3)-β-D-葡聚糖含量。将血浆BG浓度大于20.0pg/ml定义为阳性。使用由广州科祺生物技术开发技术有限公司提供的曲霉菌抗原酶免试剂盒（96T）检测半乳甘露聚糖。并计算出G实验诊断IFI的敏感性、特异性和阳性预测值以及阴性预测值。以及GM实验对于IA的的敏感性、特异性以及阳性预测值和阴性预测值。结果：明确诊断为侵袭性真菌的患者菌种分布仍以假丝酵母菌感染和烟曲霉感染为主，其中假丝酵母菌感染，又以白色假丝酵母菌为主；IFI组的血浆（1，3）-β-D葡聚糖含量为（169.73±164.34）pg/nl，非IFI组的血浆（1，3）-β-D葡聚糖含量为(12.58±9.03)pg/nl，两组相比较存在显著统计学差异(t=5.66，P0.05)。根据四格表法计算的可得到G实验诊断侵袭性真菌感染其敏感度68.18%，特异度77.27%，阳性预测值75.00%，阴性预测值70.83%。结论：1.血浆BG检测适用于早期诊断假丝酵母菌和曲霉菌引起的临床深部组织感染，可协助临床医生早期诊断用常规方法难以确诊的侵袭性真菌感染。2.血浆BG的检测是一项较为特异性的诊断真菌感染的指标，GM检测为诊断曲霉菌感染的特异性指标；3.血浆BG、GM检测方法较传统真菌涂片和培养法具有简便、快速及敏感的优点。
[Abstract]:Objective: to evaluate the value of plasma 1-3-尾-D glucan in the early diagnosis of invasive deep fungal infection (IFI). Methods: the respiratory department of the first affiliated Medical College of Xinjiang Medical University was retrospectively analyzed from June 2011 to November 2012. The respiratory intensive care unit and the infection department met the following criteria: (1) according to the criteria for diagnosis and treatment of invasive fungal infection in patients with hematologic / malignant tumor, developed by the IFI working Group of China (the third revision), (2) 66 patients who had completed plasma G test and / or GM test before antifungal therapy. Among all the inpatients, 66 patients in IFI group were matched according to age, sex and underlying diseases. 66 non-IFI patients were set as control group. MB-80 microorganism rapid dynamic monitoring system and GKT-1MSet dynamic fungal detection kit were used to detect plasma (lc3)-尾 -Dglucan content. Plasma BG concentration greater than 20.0pg/ml was defined as positive. Galactomannan was detected with Aspergillus antigens enzyme immunoassay kit (96T) provided by Guangzhou Keqi Biotechnology Development Co., Ltd. The sensitivity, specificity, positive predictive value and negative predictive value of G-test in the diagnosis of IFI were calculated. And the sensitivity, specificity, positive predictive value and negative predictive value of GM test for IA. Results: the infection of Candida and Aspergillus fumigatus was still the main infection in the patients diagnosed as invasive fungi, among which Candida cerevisiae and Candida albicans were the main ones. The plasma levels of (1t3)-尾 -D glucan were (169.73 卤164.34) PG / nl in IFI group and (12.58 卤9.03) PG / nl in non-IFI group. There was significant difference between the two groups (t 5.66 P 0.05). The sensitivity, specificity, positive predictive value, negative predictive value and negative predictive value were 68.18, 77.27, 75.00 and 70.83, respectively. Conclusion 1. The detection of plasma BG is suitable for the early diagnosis of clinical deep tissue infection caused by Candida cerevisiae and Aspergillus sp. It can assist clinicians in the early diagnosis of invasive fungal infection which is difficult to be diagnosed by conventional methods. The detection of plasma BG is a relatively specific indicator for the diagnosis of fungal infection. GM detection is a specific index for the diagnosis of aspergillus infection. Compared with the traditional fungal smear and culture method, the detection of plasma BGG GM has the advantages of simplicity, rapidity and sensitivity.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R519

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