评估国产(1,3)-β-D-葡聚糖检测试剂的诊断价值

中国真菌学杂志　 2010, Vol. 5 　Issue (5): 277-281.

评估国产(1,3)-β-D-葡聚糖检测试剂的诊断价值

高露娟, 余进, 王晓红, 万喆, 李若瑜

北京大学第一医院皮肤性病科, 真菌和真菌病研究中心, 北京, 100034

收稿日期:2010-04-08 出版日期:2010-10-28 发布日期:2010-10-28
通讯作者: 余进,E-mail:yujin676@gmail.com E-mail:yujin676@gmail.com
作者简介:高露娟,女(汉族),博士研究生在读,住院医师.E-mail:nonagao@hotmail.com
基金资助:
国家自然科学基金(30600027);公益性卫生行业科研专项项目(200802026)

Diagnostic value of Chinese assay of (1,3)-β-D-glucan in invasive fungal infections

GAO Lu-juan, YU Jin, WANG Xiao-hong, WAN Zhe, LI Ruo-yu

Department of Dermatology and Venereology, Peking University First Hospital, Peking University Research Center for Medical Mycology, Beijing 100034, China

Received:2010-04-08 Online:2010-10-28 Published:2010-10-28

摘要/Abstract

摘要： 目的比较国产与进口(1,3)-β-D-葡聚糖(BG)检测试验并对国产试剂在侵袭性真菌感染中的诊断价值进行评估。方法回顾性调查2008年4月～2009年5月我院203例(342份样本)怀疑侵袭性真菌感染的住院患者,根据诊断标准分为感染组和非感染组,对其中同时进行国产与日本试剂检测的100份样本进行配对t检验比较;在不同的判断标准下计算国产试剂的灵敏度、特异度、阳性预测值和阴性预测值等,采用McNemar配对χ²检验对不同方法进行比较。结果国产和日本试剂在感染组和非感染组配对t检验结果分别为P=0.235,P=0.076;国产试剂以单次≥20pg/mL和≥50pg/mL为界值的灵敏度、特异度分别为78.3%,67.2%和56.5%,85.0%,双次≥20pg/mL和≥50pg/mL为界值的灵敏度、特异度分别为25.0%,64.9%和25.0%,87.7%。结论国产与日本试剂检测值无统计学差异;国产试剂单次≥50pg/mL为界值较20pg/mL可以明显提高特异度,降低假阳性率,而不影响灵敏度。连续双份血清阴性(BG<50pg/mL)具有较高的特异度和阴性预测值。

关键词: (1,3)-β-D-葡聚糖, 诊断, 国产试剂, 日本试剂

Abstract: Objective To evaluate the diagnostic value of Chinese assay of (1,3)-β-D-glucan in invasive fungal infections (IFI) and compare with Japenese assay.Methods A retrospective study was performed on 203 patients at risk of IFI (totally 342 sanmples) in our hospital from April,2008 to May,2009.Paired-sample t test was analyzed in 100 samples which were detected by both Chinese and Japanese assay.Sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) were calculated under different criterion,which was compared by McNemar paired χ² test.Results The significance values of t test between the two assays were 0.235 for IFI samples and 0.076 for non-IFI samples,respectively.For Chinese assay ,the sensitivity (78.3%,56.5%,25.0%,25.0%) and specificity (67.2%,85.0%,64.9%,87.7%) were obtained by single cutoff values or double cutoff values of 20 pg/mL,50 pg/mL respectively.Conclusions There is no statistical significance between Chinese and Japanese assays.The specificity with single cutoff value of 50 pg/mL was significantly elevated without evident influence on sensitivity compared with that with 20 pg/mL.The NPV and specificity were elevated with double cutoff values.

Key words: (1,3)-β-D-glucan, diagnosis, Chinese assay, Japanese assay

中图分类号:

R446.53

高露娟, 余进, 王晓红, 万喆, 李若瑜. 评估国产(1,3)-β-D-葡聚糖检测试剂的诊断价值[J]. 中国真菌学杂志, 2010, 5(5): 277-281.

GAO Lu-juan, YU Jin, WANG Xiao-hong, WAN Zhe, LI Ruo-yu. Diagnostic value of Chinese assay of (1,3)-β-D-glucan in invasive fungal infections[J]. Chinese Journal of Mycology, 2010, 5(5): 277-281.

参考文献

[1] Pfeiffer CD,Fine J P,Safdar N.Diagnosis of invasive aspergillosis using a galactomannan assay:a meta-analysis[J].Clin Infect Dis,2006,42(10):1417-1427.
[2] Maertens J,Theunissen K,Lodewyck T,et al.Advances in the serological diagnosis of invasive Aspergillus infections in patients with haematological disorders[J].Mycoses,2007,50(Suppl1):2-17.
[3] Pfaller M A,Diekema DJ.Epidemiology of invasive candidiasis:a persistent pubfic health problem[J].Clin Microbiol Rev,2007,20(1):133-163.
[4] Persat F,Ranque S,Derouin F,et al.Contribution of the(1->3)-beta-D-gluean assay for diagnosis of invasive fungal infections[J].J Clin Microbiol,2008,46(3):1009-1013.
[5] Odabasi Z,Mattiuzzi G,Estey E,et al.Beta-D-glucan as a diagnostic adjunct for invasive fungal infections:validation,cutoff development,and performance in patients with acute myelogenons leukemia and myelodysplastic syndrome[J].Clin Infect Dis,2004,39(2):199-205.
[6] Pazos C,Ponton J,Del PA.Contribution of(1->3)-beta-Dglucan chromogenic assay to diagnosis and therapautic monitoring of invasive aspergillosis in neutropenic adult patients:a comparison with serial screening for circulating galactomannan[J].J Clin Microbiol,2005,43(1):299-305.
[7] Pickering JW,Sant HW,Bowles CA,et al.Evaluation of a(1->3)-beta-D-glucan assay for diagnosis of invasive fungal infections[J].J Clin Microbiol,2005,43(12):5957-5962.
[8] Senn L,Robinson JO,Schmidi S,et al.1,3-Beta-D-glucan antigenemia for early diagnosis of invasive fungal infections in neutropenic patients with acute leukemia[J].Clin Infect Dis,2008,46(6):878-885.
[9] Ostrosky-Zeichner L,Alexander BD,Kett DH,et al.Multicenter clinical evaluation of the(1->3)beta-D-glucan assay as an aid to diagnosis of fungal infections in humans[J].Clin Infect Dis,2005,41(5):654-659.
[10] Marty FM,Koo S.Role of(1->3)-beta-D-glucan in the diagnosis of invasive aspergillosis[J].Med Mycol,2009,47(Suppl1):S233-S240.
[11] Tasaka S,Hasegawa N,Kobayashi S,et al.Serum indicators for the diagnosis of pneumocystis pneumonia[J].Chest,2007,131(4):1173-1180.
[12] 赵勇,王红,任爱民,等.血浆β-1,3-D-葡聚糖对深部真菌感染诊断的研究[J].中国真菌学杂志,2007,2(4):202-206.
[13] 张建芳,徐修礼,樊新,等.深部真菌感染患者血浆1-3-β-D葡聚糖检测的临床意义[J].中华医院感染学杂志,2005,15(3):354-355.
[14] 刘芳,吴彤,蔡鹏,等.血浆(1,3)-β-D葡聚糖检测对血液病患者侵袭性真菌感染的诊断价值[J].中国实验血液学杂志,2009,7(4):1043-1046.
[15] 陈宇清,高蕾,朱小敏,等.血浆(1,3)-β-D-葡聚糖抗原检测对器官移植术后患者侵袭性肺部真菌感染的诊断价值[J].实用临床医药杂志,2009,13(5):2-6.