G试验在侵袭性念珠菌病中的临床价值

摘要/Abstract

摘要：

目的探讨G试验在侵袭性念珠菌病（invasive candidiasis，IC）中的诊断价值及其与患者粒细胞、病原菌、体温之间的关系。方法选取暨南大学附属五邑中医院2015年9月至2018年6月期间55例IC患者、42例侵袭性曲霉菌病（invasive aspergillosis，IA）患者、30名念珠菌黏膜定植者、50名健康人群，采用免疫比浊法检测各组G试验浓度；采用ROC曲线分析G试验在IC患者中的诊断价值；同时比较G试验阳性率与IC患者粒细胞、病原菌、体温之间的关系；结果采用SPSS 19.0进行统计分析。结果 IC患者G试验水平显著高于健康人群、念珠菌黏膜定植患者和IA患者（P<0.05）。55例IC患者中，非白念珠菌例数（32例）超过白念珠菌（23例）。分别以非侵袭性真菌组（invasive fungal disease，IFD）和非IC组作为对照组，G试验诊断IC患者的ROC曲线下面积（AUC）为0.899和0.782。粒细胞正常组IC患者G试验阳性率与粒细胞增高组、粒细胞减少组之间无统计学差异（P>0.05），但显著高于粒细胞缺乏组（P<0.05）；白念珠菌IC组G试验阳性率与热带和光滑念珠菌组差异无统计学意义（P>0.05），但显著高于其他念珠菌感染组（P<0.05）；G试验阳性率在不同体温组IC患者均无统计学差异（P>0.05）。结论 G试验在IC患者中具有较高的诊断价值，不仅可区分致病菌和定植菌，还对IC和IA的鉴别具有一定的价值；G试验阳性率与IC患者的粒细胞缺乏和感染的病原菌类型相关，与体温无关。

关键词: G试验, 念珠菌, 曲霉菌, 侵袭, 诊断

Abstract:

Objective To explore the diagnostic value of G test in invasive candidiasis (IC) and its relationship with neutrophils, pathogen, and body temperature in patients. Methods Fifty-five patients with IC, 42 patients with invasive aspergillosis(IA), 30 cases of Candida mucosa colonizer, 50 healthy people were collected from September 2015 to June 2018 in Wuyi Traditional Chinese Medicine Hospital Affiliated of Ji nan University, the level of G test were detected by immuneturbidimetry. Diagnostic value of G test in IC patients was assessed by ROC analysis. The relationships between positive rate of G test and neutrophils, pathogen, body temperature in patients with IC were also compared. SPSS19.0 was used for statistical analysis. Results The level of G test in IC patients was significantly higher than these of healthy people, Candida colonizers and IA patients(P<0.05). Among 55 patients with IC, the number of non-Candida albicans (32 cases) was higher than that of Candida albicans (23 cases). Non-IFD group and non-IC group were used as the control group, the area under the ROC curve (AUC) of the G test diagnostic IC patients was 0.899 and 0.782. The positive rate of G test in IC patients with neutrophil normal group was not significant different from those of neutrophil increase group and neutrophil reduction group (P>0.05), but it was significantly higher than that of neutrophil deficiency group (P<0.05).The positive rate of G test in Candida albicans group was not significantly different from that in the Candida tropicalis and Candida glabrata group (P>0.05), but significantly higher than that in other Candida infection group(P<0.05). There were no significant differences in the positive rate of G test between IC patients in different temperature groups(P>0.05). Conclusion G test has high diagnostic value in IC patients. It can distinguish Pathogenic bacteria and colonization bacteria, and has certain value for the identification of IC and IA. The positive rate of G test is related to the neutrophil deficiency and the type of pathogen, and not related to body temperature in IC patients.

Key words: G test, candidiasis, aspergillosis, invasion, diagnosis

中图分类号:

申旺, 杨文丽, 叶丽燕, 谭晓宇, 黄晨娟, 张鑫. G试验在侵袭性念珠菌病中的临床价值[J]. 中国真菌学杂志, 2019, 14(2): 78-82.

SHEN Wang, YANG Wen-li, YEL-yan, TAN X-yu, HUANGC-juan, ZHANG Xin. Clinical value of G test in invasive candidiasis[J]. Chinese Journal of Mycology, 2019, 14(2): 78-82.

参考文献

[1] Koehler P, Cornely OA. Contemporary strategies in the prevention and management of fungal infections[J].Infect Dis Clin North Am, 2016, 30(1):265-275.
[2] 申旺, 叶丽燕, 杨文丽, 等. 血浆(1,3)-β-D-葡聚糖在侵袭性真菌感染临床诊治中的应用评价[J].中华医院感染学杂志,2018,28(9):1288-1291.
[3] 朱晓琳, 唐爱国, 胡敏, 等. 联合测定血液中(1,3)-β-D-葡聚糖和半乳甘露聚糖对侵袭性真菌病早期诊断价值的荟萃分析[J].临床检验杂志,2017,35(1):72-75.
[4] Pini P, Bettua C, Orsi CF, et al. Evaluation of serum (1,3)-β-D-glucan clinical performance:kinetic assessment, comparison with galactomannan and evaluation of confounding factors[J].Infection, 2016, 44(2):223-233.
[5] 中国侵袭性真菌感染工作组.血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准和治疗原则[J].中华内科杂志,2013,52(8):704-709.
[6] Paramythiotou E, Frantzeskaki F, Flevari A, et al. Invasive fungal infections in the ICU:how to approach, how to treat[J]. Molecules, 2014, 19(1):1085-1119.
[7] Litvintseva AP, Lindsley MD, Gade L,et al. Utility of (1,3)-β-D-glucan testing for diagnostics and monitoring response to treatment during the multistate outbreak of fungal meningitis and other infections[J].Clin Infec Dis,2014,58(5):622-630.
[8] Mikulska M, Furfaro E, Viscoli C. Non-cultural methods for the diagnosis of invasive fungal disease[J]. Expert Rev Anti Ther, 2015,13(1):103-117.
[9] 秦晓峰, 王英, 吴建华, 等. 院内深部念珠菌感染菌种的分布和耐药性分析[J].中国真菌学杂志,2016,11(3):166-168.
[10] Wang H,XiaoM,Chen CA,et al. In vitro susceptibilities of yeast species to fluconazole and voriconazole as determined by the 2010 National China Hospital Invasive Fungal Surveillance Net(CHIF-NET) study[J].J Clin Microbiol,2012,50(12):3952-3959.
[11] 刘雅, 肖玉玲, 康梅, 等. 侵袭性白念珠菌感染的危险因素及耐药性变迁[J].中国抗生素杂志,2014,39(10):780-784.
[12] LoCascio G, Koncan R, Stringari G, et al. Interference of confounding factors on the use of (1,3)-β-D-glucan in the diagnosis of invasive candidiasis in the intensive care unit[J]. Eur J Clin Microbiol Infect Dis, 2015, 34(2):357-365.
[13] 磨立达, 苏国生, 麻秋英, 等. G试验对HIV/AIDS患者合并侵袭性真菌感染的诊断价值[J].中国实验和临床感染病杂志(电子版),2017,11(8):345-351.
[14] Mccarthy MW, Petraitiene R, Walsh TJ. Translational development and application of (1,3)-β-D-glucan for diagnosis and therapeutic monitoring of invasive mycoses[J]. Int J Mol Infect Sic, 2017, 18(6):1124.
[15] 李方义, 邹子俊, 李伟超, 等. 1,3-β-D-葡聚糖和半乳甘露聚糖检测在侵袭性真菌病诊疗中的临床意义研究[J].转化医学电子杂志,2016,3(6):64-66.