血清(1,3)-β-D葡聚糖试验与血清半乳甘露聚糖试验对马尔尼菲篮状菌病的诊断价值

摘要/Abstract

摘要： 目的探讨血清（1，3）-β-D-葡聚糖检测（G试验）、血清半乳甘露聚糖试验（GM试验）及联合检测对艾滋病（AIDS）患者中合并马尔尼菲篮状菌病（TSM）的诊断价值。方法回顾性研究住院艾滋病患者中有明确病原学检查确诊马尔尼菲篮状菌（TM）感染且有完善G试验及GM试验的患者45例，及同期住院AIDS患者中有完善G试验、GM试验及病原学检查，明确排除TM感染的219例患者，比较各组G试验、GM试验结果、检测时间，通过对比G试验、GM试验及联合检测方法（联合检测一：G试验和GM试验检测均为阳性为联合检测阳性，一种阳性或均阴性视为阴性结果；联合检测二：单独G试验或GM试验检测为阳性或二者均阳性，即为联合检测阳性，均阴性视为阴性结果）的敏感度、特异度、阳性预测值、阴性预测值、误诊率、漏诊率，并绘制ROC曲线。结果 G试验及GM试验的敏感度及特异度差异有统计学意义（P<0.05），G试验敏感度为36.36%，特异度为78.14%，ROC曲线下面积AUC为0.602，95%的置信区间为0.539~0.662。GM试验敏感度为55.56%，特异度为96.80%，ROC曲线下面积AUC为0.819，95%CI为0.767~0.864。联合检测一敏感度27.27%，特异度99.53%，ROC曲线下面积AUC为0.634，95%CI为0.572~0.693。联合检测二敏感度65.91%，特异度76.74%，ROC曲线下面积AUC为0.713，95%CI为0.654~0.768，约登指数为0.4265。结论 G试验、GM试验是AIDS合并TSM早期辅助性诊断指标，其中GM试验敏感度、特异度均高于G试验，相比病原学检查，有缩短诊断时间的优点，但不是诊断金标准。在G试验、GM试验及联合检测中，联合检测一可以提高特异度，联合检测二可以提高敏感度。

关键词: 艾滋病, 马尔尼菲篮状菌病, 血清(1,3)-β-D-葡聚糖检测, 血清半乳甘露聚糖抗原检测, 诊断

Abstract: Objective To investigate the diagnostic value of serum (1,3) -β-D-glucan test (G test), serum galactomannan test (GM test) and combined test in patients with AIDS complicated with Talaromycosis marneffei (TSM). Methods A retrospective study of 45 cases of hospitalized AIDS patients in the family a clear etiology examination and diagnosis Talaromyces marneffei(TM) and at the same time with G test and GM test. and the same period and at the same time with G test, GM test and etiology examination, explicitly exclude TM infection of 219 hospitalized AIDS patients, comparison the G test and GM test results and time between the two groups.By comparing the sensitivity, specificity, positive predictive value, negative predictive value, misdiagnosis rate and missed diagnosis rate of G test, GM test and the combined detection method(Combined test 1:if the G test and the GM test are both positive, the combined test is positive; if the other one is positive or both negative, the combined test is negative.Combined test 2:if the G test or GM test alone is positive or both are positive, the combined test is positive; if both are negative, the result will be considered negative), and drawing the ROC curve.Results The sensitivity and specificity of G test and GM test were statistically significant (P < 0.05).The sensitivity and specificity of G test were 36.36%, 78.14%, the AUC under ROC curve was 0.602, and the 95% confidence interval (CI) was 0.539 to 0.662.The sensitivity of GM test was 55.56%, the specificity was 96.80%, the AUC under ROC curve was 0.819, and the 95% CI was 0.767 to 0.864.The sensitivity and specificity of the combined detection were 27.27%, 99.53%, AUC under ROC curve was 0.634, and 95% CI was 0.572 to 0.693.The sensitivity and specificity of the combined detection were 65.91% and 76.74%, the AUC under the ROC curve was 0.713, 95% CI was 0.654 to 0.768, Youden index was 0.4265. Conclusion G test and GM test are auxiliary diagnostic indicators of AIDS combined with TSM in early stage. The sensitivity and specificity of GM test are higher than that of G test.Compared with etiological examination, GM test has the advantage of shortening the diagnosis time,but both of them are not the gold standards. Combined test 1 can improve the sensitivity. Combined test 2 can improve the specificity.

Key words: AIDS, Talaromycosis marneffei, detection of serum (1,3)-β-D-glucan, serum galactomannan test, diagnosis

中图分类号:

R446.5 R519.8A

郑祎, 何云, 刘甲野, 贺守第, 孙丽琴, 王辉. 血清(1,3)-β-D葡聚糖试验与血清半乳甘露聚糖试验对马尔尼菲篮状菌病的诊断价值[J]. 中国真菌学杂志, 2022, 17(5): 385-390.

ZHENG Yi, HE Yun, LIU Jiaye, HE Shoudi, SUN Liqin, WANG Hui. Diagnostic value of serum (1,3) -β-D glucan test and serum galactomannan test for Talaromyces marneffei[J]. Chinese Journal of Mycology, 2022, 17(5): 385-390.

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