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免疫功能低下患者的侵袭性真菌感染(IFI)具有病死率高,诊断困难等特点。针对真菌病原的血清学方法如(1,3)-β-D葡聚糖(BG)检测(G试验)、曲霉半乳甘露聚糖检测(GM试验)具有操作简单、快速、敏感性相对高等特点,可做为IFI诊断的辅助手段。较GM试验比,G试验可用于诊断除曲霉菌外更多的真菌感染。本研究旨在探讨G试验在血液病患者IFI早期诊断中的价值。血浆标本来源于2007年5月-2008年5月来自北京道培医院162例疑为IFI的血液病患者,其中化疗后患者85例,造血干细胞移植后患者77例。应用MB-80微生物动态快速检测系统定量检测患者血浆中BG的含量,将检测结果及临床特征进行回顾性分析。按照欧洲癌症研究治疗组织及真菌研究组(EORTC/MSG)诊断标准,所有病例中有确定诊断2例,临床诊断18例,拟诊75例,排除诊断67例。结果表明:以20ng/ml为诊断界值,G试验的敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)分别为75%、91%、72.4%和92.4%。在75例拟诊病例中,其中有51例G试验阳性,且对广谱抗生素无效而经过抗真菌治疗有效,经过临床回顾性分析符合IFI,表明G试验使IFI诊断率提高31.4%。结论:G试验是早期诊断血液病患者IFI的简单、快速的方法。
Infectious fungal infections (IFI) in immunocompromised patients are characterized by high rates of mortality and difficulty in diagnosis. Serological methods for fungal pathogens such as (1,3) -β-D-glucan (BG) assay (G test), Aspergillus galactomannan assay (GM test) are simple, rapid and sensitive Features, can be used as an aid to IFI diagnosis. Compared with GM test, G test can be used to diagnose more fungal infections besides Aspergillus. The purpose of this study was to investigate the value of the G test in the early diagnosis of IFI in hematological diseases. Plasma samples were obtained from 162 suspected IFI patients with blood diseases from Beijing Pei Pei Hospital from May 2007 to May 2008, including 85 patients after chemotherapy and 77 patients after hematopoietic stem cell transplantation. MB-80 microbial rapid dynamic detection system was used to quantitatively detect the content of BG in the plasma of patients. The detection results and clinical features were retrospectively analyzed. According to the diagnostic criteria of EORTC / MSG in European Organization for the Study of Cancer Therapy and Erythromycin (MS), 2 cases were confirmed, 18 cases were diagnosed, 75 cases were diagnosed and 67 cases were excluded. The results showed that the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of G test were 75%, 91%, 72.4% and 92.4% respectively at the diagnostic cutoff of 20ng / ml. Among the 75 cases that were diagnosed, 51 of them were positive in the G test and were ineffective against broad-spectrum antibiotics and were effectively treated with antifungal agents. The clinical analysis was in line with IFI, indicating that the G test increased the IFI diagnosis rate by 31.4%. Conclusion: The G test is a simple and rapid method for the early diagnosis of IFI in patients with hematological diseases.