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目的探讨1,3-β-D-葡聚糖检测(G试验)联合曲霉半乳甘露聚糖检测(GM试验)对儿童恶性血液病侵袭性真菌感染(IFI)的诊断价值。方法恶性血液病患儿421例分为IFI组(86例)和非IFI组(335例),应用MB-80微生物动态快速检测系统和ELISA法分别检测血浆1,3-β-D葡聚糖以及血清曲霉半乳甘露聚糖含量。G试验和GM试验分别以20pg/ml和0.5pg/ml作为诊断界值,计算单独和联合应用诊断IFI的敏感性、特异性、阳性预测值和阴性预测值。结果 G试验的敏感性、特异性、阳性预测和阴性预测值分别为80.2%、89.0%、65.1%和97.7%;GM试验的敏感性、特异性、阳性预测和阴性预测值分别为65.1%、76.7%、36.4%和89.5%;G试验和GM试验联合检测IFI的敏感性、特异性、阳性预测和阴性预测值分别为100%、70.7%、46.7%和100%。G试验和GM试验联合检测IFI的敏感性高于单一G试验或GM试验(P<0.05)。结论与单一G试验或GM试验比较,联合检测诊断IFI的敏感性高,是诊断儿童恶性血液病IFI的高效方法。
Objective To investigate the diagnostic value of 1,3-β-D-glucan (G test) in combination with Aspergillus oryzae mannan (GM) in the diagnosis of invasive fungal infection (IFI) in children with hematologic malignancies. Methods A total of 421 children with hematologic malignancies were divided into two groups: IFI group (n = 86) and non-IFI group (n = 335). MB-80 microbiological rapid detection system and ELISA method were used to detect plasma 1,3-β-D glucan Aspergillus oryzae galactomannan content. The sensitivity, specificity, positive predictive value, and negative predictive value of IFI alone and in combination for the diagnosis of IFI were calculated at 20 pg / ml and 0.5 pg / ml as diagnostic cutoffs in the G and GM trials, respectively. Results The sensitivity, specificity, positive predictive value and negative predictive value of G test were 80.2%, 89.0%, 65.1% and 97.7%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of GM test were 65.1% 76.7%, 36.4% and 89.5%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of IFI in G test and GM test were 100%, 70.7%, 46.7% and 100% respectively. The sensitivity of the G test and the GM test in combination with IFI was higher than that of the single G test or the GM test (P <0.05). Conclusion Compared with a single G test or GM test, the combined detection of high sensitivity of IFI diagnosis is an effective method to diagnose IFI in children with hematologic malignancies.