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目的评价临床常规工作状态下降钙素原(PCT)与(1,3)-β-D葡聚糖(G试验)单独及联合应用诊断肺部感染的实际效能。方法收集病例1 027例,统计痰涂片及培养阳性分离菌分布组成,分别与微生物检验和胸部CT比对研究PCT和G试验的诊断价值,并研究微生物检验阳性与CT推断性诊断时G试验值分布,系统评价G试验与PCT联合应用对肺部感染的预测能力。结果病原菌分离以烟曲霉菌、多重耐药菌、结核分枝杆菌为主;与微生物检验比较时PCT特异性41.2%,敏感性66.4%;在微生物检验与CT均诊断为肺曲霉菌感染的病例中,G试验中位数与均数均小于临界值;与微生物检验比较,G试验特异性84.1%,敏感性13.2%;在一致病例中G试验中位值112.91,95%CI分布60~768;CT为参照,G试验特异性75.0%,敏感性21.4%;疑似肺源性败血症病例中,PCT的中位值7.51,三个病例PCT低于阈值;三个病例G试验假阳性。两项检查同时阳性对肺部真菌感染的预测能力仅2.30%,对细菌感染为5.40%;大部分肺部真菌感染的患者PCT并不升高;某些细菌感染G试验也可能升高。结论对于PCT与G试验测定应该谨慎对待,合理分析,综合评价后有选择性的参考。
Objective To evaluate the clinical efficacy of procalcitonin (PCT) and (1,3) -β-D-glucan (G test) alone and in combination to diagnose pulmonary infection in routine clinical practice. Methods A total of 1 027 cases were collected, and the distribution of sputum smear and culture positive isolates were collected. The diagnostic value of PCT and G tests were compared with those of the microbiology test and chest CT respectively. The G test Value distribution, systematic review G test and PCT combined application of the ability to predict lung infection. Results The pathogenic bacteria were mainly Aspergillus fumigatus, multidrug-resistant bacteria and Mycobacterium tuberculosis. The specificity of PCT was 41.2% and the sensitivity was 66.4% when compared with that of the microorganism test. The cases of pulmonary aspergillosis were diagnosed by microbiological test and CT The median and mean G test were less than the critical value. Compared with the microbiological test, the G test had a specificity of 84.1% and a sensitivity of 13.2%. In the consistent case, the G test had a median of 112.91 and a 95% CI of 60 to 768 ; CT as a reference, G test-specific 75.0%, sensitivity 21.4%; suspected pulmonary septicemia cases, PCT median 7.51, three cases of PCT below the threshold; three cases of G test false positive. The positive predictive value of both tests for pulmonary fungal infection was only 2.30% for bacterial infections and 5.40% for bacterial infections; PCT was not elevated for most patients with pulmonary fungal infections; and some bacterial infections may be elevated for G tests. Conclusion The PCT and G test should be treated with caution, reasonable analysis, comprehensive evaluation of the selective reference.