G试验及GM试验对非粒细胞缺乏患者侵袭性肺真菌感染的诊断意义

发布时间：2018-05-23 06:27

本文选题：支气管肺泡灌洗液 + 血清　；参考：《山东大学》2017年硕士论文

【摘要】：研究目的探讨1,3-β-D-葡聚糖检测(G试验)及半乳甘露聚糖抗原检测(GM试验)对非粒细胞缺乏的侵袭性肺部真菌感染(IPFI)患者早期诊断的意义,以便更好地指导临床治疗。研究方法收集山东省立医院呼吸内科2011年1月至2017年03月住院期间疑诊IPFI且无粒细胞缺乏史的149位患者的病史资料进行回顾性分析,将52例拟诊IPFI,42例临床诊断IPFI以及12例确诊IPFI纳入IPFI组,诊断非IPFI的43例为非IPFI组。比较2组血清1,3-β-D-葡聚糖及半乳甘露聚糖水平,并分析血清G/GM试验诊断IPFI的灵敏度、特异度以及cut off值。亚组研究:收集的149例研究对象中有19例同时检测了血清和肺泡灌洗液中半乳甘露聚糖水平,将12例拟诊、临床诊断及确诊的IPFI患者纳入观察组,7例诊断非IPFI患者纳入对照组,比较两种GM检测方法在不同界定值下诊断IPFI的灵敏度、特异度、阳性预测值及阴性预测值。结果1)IPFI组血清1,3-β-D-葡聚糖水平相较非IPFI组是明显高的(P=0.019);诊断IPFI的灵敏度为39.6%,特异度为89.4%,cut off值为152.8 pg/ml。2)IPFI组血清半乳甘露聚糖水平显著高于非IPFI组(P=0.000);诊断IPFI的灵敏度为52.9%,特异度为77.5%,cut off值为0.4615 ug/L。3)亚组研究:观察组BALF中半乳甘露聚糖水平与对照组相比,存在显著性的统计学差异(P=0.000),且显著高于同组血清半乳甘露聚糖水平(P=0.001)。当GM试验界值取0.5时,BALF GM诊断IPFI的灵敏度、特异度、PPV 及 NPV 分别是 91.67%,85.71%,91.67%和 85.71%,而血清GM 则分别为 33.33%,57.14%,57.14%和 33.33%。而取 1.0 时,BALF GM试验除了灵敏度不变外都有提高,分别是91.67%,100%,100%和87.50%,且均高于血清 GM 试验(25%,85.71%,75%,40%)。结论及意义1)血清G/GM试验诊断非中性粒细胞缺乏的侵袭性肺真菌感染灵敏度较低,特异度较高,对其早期诊断仍有一定价值。2)初步探究BALF GM试验对非中性粒细胞缺乏的侵袭性肺真菌感染的诊断意义发现,其灵敏度及特异度均优于血清样本;在界值为1.Oug/L时,其临床诊断价值可达最佳;但因其为侵入性肺部操作,临床应用时应注意评估患者情况及避免造成真菌定植的风险。
[Abstract]:Objective to investigate the significance of 1t3- 尾 -Dglucan test (G test) and galactomannan antigen test (GM test) in early diagnosis of invasive pulmonary fungal infection (IPFI) with non-granulocytic deficiency in order to better guide clinical treatment. Methods data of 149 patients with suspected IPFI who had no history of granulocytic deficiency during hospitalization from January 2011 to March 2017 in Department of Respiratory Medicine of Shandong Provincial Hospital were retrospectively analyzed. Forty-two cases of clinically diagnosed IPFI and 12 cases of confirmed IPFI were included in IPFI group. 43 cases of non-IPFI were diagnosed as non-IPFI group. The serum levels of 1t3- 尾 -D- glucan and galactomannan were compared between the two groups, and the sensitivity, specificity and cut off value of serum G/GM test in the diagnosis of IPFI were analyzed. Subgroup study: 19 of 149 subjects were tested for galactomannan levels in both serum and alveolar lavage fluid. 12 patients with IPFI were included in the observation group, and 7 patients with non IPFI were included in the control group. The sensitivity, specificity, positive predictive value and negative predictive value of the two methods for the diagnosis of IPFI were compared. Results the serum level of 1t3- 尾 -D- glucan in 1)IPFI group was significantly higher than that in non-IPFI group (P 0.019), the sensitivity in diagnosis of IPFI was 39.6, the specificity was 89.4 and the off value of 152.8 pg/ml.2)IPFI was significantly higher than that in non-IPFI group, and the sensitivity in the diagnosis of IPFI was 52.9%. The subgroup study on the specificity of 77.5 cut off was 0.4615 ugr / L. 3) subgroup: the level of galactomannan in BALF in the observation group was higher than that in the control group. There was significant statistical difference (P < 0. 000), and it was significantly higher than the serum galactomannan level of the same group (P < 0. 001). When the threshold value of GM test was 0.5, the sensitivity of BALF GM in the diagnosis of IPFI was 91.67% and 85.71%, respectively, and the specificity of NPV was 91.67% and 85.71%, respectively, while the serum GM was 33.333,57.14% and 33.33%, respectively. However, the sensitivity of BALF GM test increased by 91.67% and 87.50%, respectively, and was higher than that of serum GM test. Conclusion and significance 1) the sensitivity and specificity of serum G/GM test in the diagnosis of invasive pulmonary fungal infections with non-neutrophil deficiency were lower and higher. To explore the significance of BALF GM test in the diagnosis of invasive pulmonary fungal infection with non-neutrophil deficiency, the sensitivity and specificity of the test were higher than those of serum samples, and when the threshold value was 1.Oug/L, the sensitivity and specificity of the test were better than those of serum samples. Its clinical diagnostic value is the best, but because it is an invasive pulmonary operation, it should be paid attention to evaluate the patient's condition and avoid the risk of fungal colonization.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R519

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