定量PCR检测联合G试验及GM试验对侵袭性真菌感染早期诊断的价值

摘要/Abstract

摘要： 目的探讨荧光定量PCR(RTFQ-PCR)检测联合G试验及GM试验对侵袭性真菌感染早期诊断的价值。方法纳入2014年4月—2015年10月我院(宁夏医科大学总医院)ICU、呼吸科及烧伤科等侵袭性真菌感染高发科室中60例IFI高危患者,对60 例患者进行血、痰及肺泡灌洗液组织样本真菌培养,并进行血浆(1,3)-β-D葡聚糖检测(G试验)、半乳甘露聚糖抗原检测(GM试验)以及荧光定量RTFQ-PCR检测,观察3种检测方法及联合检测的准确性、灵敏度及特异性,并进行ROC曲线分析,评价荧光定量RTFQ-PCR对IFI的诊断价值。结果 G试验IFI确诊组、临床诊断组、拟诊组及排除组检出阳性率分别为100%、70.37%、75.00%和54.55%;GM试验IFI确诊组、临床诊断组、拟诊组及排除组检出阳性率分别为66.67%、70.37%、62.50%和45.45%;RTFQ-PCR检测IFI确诊组、临床诊断组、拟诊组及排除组检出阳性率分别为100%、81.48%、87.50%和22.73%;G试验敏感度为81.58%,特异性59.09%,阳性预测值77.50%,阴性预测值65.00%,符合度为73.33%;GM试验敏感度为76.32%,特异性68.18%,阳性预测值80.56%,阴性预测值62.50%,符合度为73.33%;RTFQ-PCR检测敏感度为84.21%,特异性77.27%,阳性预测值86.49%,阴性预测值73.91%,符合度为73.91%;RTFQ-PCR+G+GM联合检测敏感度为55.26%,特异性95.45%,阳性预测值95.45%,阴性预测值55.26%,符合度为70.00%。结论 G试验、GM试验、RTFQ-PCR检测在IFI诊断中均具有较高的临床应用价值(P均<0.05),但G试验、GM试验在IFI诊断中假阳性率较高,故在单种方式检测中推荐RTFQ-PCR检测,而RTFQ-PCR+G+GM联合检测则能够明显提高IFI临床诊断准确性。

关键词: 侵袭性真菌感染, 真菌培养, RTFQ-PCR检测, 联合检测, 诊断价值

Abstract: Objective To explore the value of RT-PCR (RTFQ-PCR) detection combined with G test and GM test in the early diagnosis of invasive fungal infection. Method From April 2014 to October 2015, 60 cases at high risk of IFI from several departments including ICU of our hospital were enrolled. Fungal culture of blood, phlegm and alveolar lavage tissue samples, plasma (1,3) -β-D-glucan assay (G test), galactomannan antigen assay (GM test) and fluorescence quantitative RTFQ-PCR were performed. The ROC curve analysis was conducted to evaluate the diagnostic value of fluorescence quantitative RTFQ-PCR for IFI. Results G test positive rates of IFI, clinical diagnostic, suspected and excluded groups were 100%, 70.37%, 75.00% and 54.55% respectively; GM detection positive rates were 66.67%, 70.37%, 62.50% and 45.45% respectively; The positive rates of RTFQ-PCR were 100%, 81.48%, 87.50% and 22.73%, respectively. Results of G test: sensitivity was 81.58%, specificity 59.09%, positive predictive value 77.50%, negative predictive value 65.00%, and coincidence was 73.33%. The sensitivity, specificity, positive predictive value and negative predictive value of GM test were 76.32%, 68.18%, 80.56%, 62.50% and 73.33%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and conformity of RTFQ-PCR were 84.21%, 77.27%, 86.49%, 73.91% and 73.91% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of RTFQ-PCR+G+GM combined detection were 55.26%, 95.45%, 95.45%, 55.26% and 70.00% respectively. Conclusion G test, GM test and RTFQ-PCR test showed high clinical application value in IFI diagnosis (all P < 0.05), but G test and GM test had high false positive rates in IFI diagnosis, so RTFQ-PCR test was recommended in single detection, and RTFQ-PCR+G+GM combined detection could significantly improve the accuracy of IFI clinical diagnosis.

Key words: invasive fungal infection, fungal culture, realtime fluorescence quantitative PCR, joint detection, diagnostic value

中图分类号:

R446.5
R519

尚元元, 李可心, 马春梅, 李莎莎, 扈容英, 杨文君. 定量PCR检测联合G试验及GM试验对侵袭性真菌感染早期诊断的价值[J]. 中国真菌学杂志, 2021, 16(6): 367-372.

SHANG Yuanyuan, LI Kexin, MA Chunmei, LI Shasha, HU Rongying, YANG Wenjun. The value of quantitative PCR detection combined with G test and GM test in the early diagnosis of invasive fungal infections[J]. Chinese Journal of Mycology, 2021, 16(6): 367-372.

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