血浆(1,3)-β-D葡聚糖检测对器官移植患者侵袭性真菌感染诊断价值

中国真菌学杂志　 2013, Vol. 8 　Issue (3): 151-155.

血浆(1,3)-β-D葡聚糖检测对器官移植患者侵袭性真菌感染诊断价值

刘耀婷, 陈险峰, 胡海清, 殷杏, 陈勇, 周庭银, 仲人前

上海长征医院实验诊断科, 上海 200003

收稿日期:2013-05-16 出版日期:2013-06-28 发布日期:2013-06-28
通讯作者: 仲人前,E-mail:Zhongrenqian@hotmail.com E-mail:Zhongrenqian@hotmail.com
作者简介:刘耀婷,女 (汉族),硕士,实习研究员.E-mail:yuxin2000@163.com
基金资助:
国家重点基础研究发展计划(2013CB531603)

The diagnostic value of plasma 1,3-β-D glucan to invasive fungal infection in organ transplant recipients

LIU Yao-ting, CHEN Xian-feng, HU Hai-qing, YING xing, CHEN yong, ZHOU Ting-yin, ZHONG ren-qian

Department of Laboratory Diagnostics, ChangZheng hospital, Shanghai 200003

Received:2013-05-16 Online:2013-06-28 Published:2013-06-28

摘要/Abstract

摘要： 目的探讨血浆 (1,3)-β-D葡聚糖 (BG)检测 (G试验)在诊断器官移植术后合并侵袭性真菌感染 (IFI)的诊断价值。方法回顾性分析2011年1月~2012年12月130例在本院肝、肾移植中心住院疑似IFI的患者的血浆标本,进行G实验检测。其中64例最终确诊或临床诊断为IFI患者,设为IFI组,余66例为非IFI组。应用MB-80微生物动态快速检测系统和GKT-5M Set动态真菌检测试剂盒,血浆BG浓度≥10 pg/mL判定G试验阳性。采用四格表计算G试验诊断IFI的敏感度、特异度、阳性预测值和阴性预测值。对G试验结果进行受试者特征工作曲线 (ROC曲线)分析,并计算曲线下面积。结果 130例患者中,IFI组中G试验阳性57/64,阳性率89.1%;阴性7例,假阴性率10.9%。非IFI组G试验阳性15/66,假阳性率22.7%。G试验阳性诊断IFI的敏感度、特异度、阳性预值和阴性预测值分别为89.1%,77.3%,79.2%和87.9%。根据G试验结果绘制ROC曲线,曲线下面积为0.875 (95%CI:0.813~0.937)。结论 G试验对器官移植患者IFI具有中等诊断价值。适当提高诊断界值及重复检测可较大程度地消除假阳性。

关键词: 血浆(1,3)-β-D葡聚糖, 器官移植, 侵袭性真菌感染, 诊断

Abstract: Objective To evaluate the diagnostic value of plasma 1,3-β-D glucan (BG) assay (G test) to invasive fungal infection (IFI) in organ transplant recipients.Methods By retrospectively accessing the clinical data of pediatric inpatients who underwent G test.The patients being recruited from January 2011 to December 2012 were split into two groups: group IFI comprised 64 patients with proven and probable IFI. Group control comprised 66 patients without fungal infection. G test was performed by the GKT-5M Set Kinetic Fungus Detection Kit. It was judged as positive when the plasma BG level≥10 pg/mL. 2 by 2 table was used to calculate the G test for the diagnosis of IFI sensitivity, specificity, positive predictive value and negative predictive values. Receiver operating curve (ROC) of G test was analyzed, and the area under the curve was calculated.Results In IFI group G test was positive in 57 cases, the positive rate was 89.06%. 15 cases of non-IFI group were positive, false positive rate was 22.7%. The G test sensitivity, specificity, positive and negative predictive values were89.1%,77.3%,79.2% and 87.9% respectively. According to ROC analysis, the AUC was 0.875 (95%CI: 0.813~0.937).Conclusion s G test has good diagnostic value of IFI in organ transplant patients. Appropriately higher cutoffs or continuous monitoring may significantly control false positive rate of the test.

Key words: (1-3)-β-D-glucan, organ transplant patients, invasive fungal infection, diagnosis

中图分类号:

R756.6

刘耀婷, 陈险峰, 胡海清, 殷杏, 陈勇, 周庭银, 仲人前. 血浆(1,3)-β-D葡聚糖检测对器官移植患者侵袭性真菌感染诊断价值[J]. 中国真菌学杂志, 2013, 8(3): 151-155.

LIU Yao-ting, CHEN Xian-feng, HU Hai-qing, YING xing, CHEN yong, ZHOU Ting-yin, ZHONG ren-qian. The diagnostic value of plasma 1,3-β-D glucan to invasive fungal infection in organ transplant recipients[J]. Chinese Journal of Mycology, 2013, 8(3): 151-155.

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