血浆(1,3)-β-D葡聚糖水平对艾滋病患者合并肺孢子菌肺炎诊断及预后的临床价值

摘要/Abstract

摘要： 目的探讨血浆（1，3）-β-D葡聚糖水平对艾滋病（AIDS）患者合并肺孢子菌肺炎（Pneumocystis pneumonia，PCP）的临床诊断及预后价值。方法回顾性分析柳州市人民医院2012年1月-2021年1月收治的110例AIDS患者，观察组55例为临床诊断PCP者，对照组55例为无机会性感染者。另观察组患者又分为好转组（31例）和死亡组（24例）。分别比较观察组与对照组、好转组（基线）与死亡组（基线）、好转组（基线）与治疗后（4周）、死亡组（基线）与治疗后（死亡时）间血浆（1，3）-β-D葡聚糖水平，通过ROC曲线评估（1，3）-β-D葡聚糖对AIDS患者合并PCP临床诊断及预后的价值。结果（1，3）-β-D葡聚糖水平对照组低于观察组[9.00（4.00，56.95） pg/mL vs. 182.50（100.60，355.00） pg/mL]，好转组（基线）低于死亡组（基线）[115.20（92.40，198.20） pg/mL vs. 360.70（253.50，523.20） pg/mL]，好转组（基线）高于治疗后（4周）[115.20（92.40，198.20） pg/mL vs. 34.39（10.00，81.45） pg/mL]，死亡组（基线）低于治疗后（死亡时）[360.70（253.50，523.20） pg/mL vs. 550.90（369.48，631.30） pg/mL]，（1，3）-β-D葡聚糖阳性率对照组低于观察组[21.82%vs. 92.73%]，好转组（基线）高于治疗后（4周）[87.10%vs. 25.81%]，差异均有统计学意义（P<0.05）。（1，3）-β-D葡聚糖阳性率在好转组（基线）与死亡组（基线）、死亡组（基线）与治疗后（死亡时）间差异无统计学意义（P>0.05）。当（1，3）-β-D葡聚糖≥ 77.65 pg/mL时，用于诊断PCP的敏感度、特异度、阳性预测值、阴性预测值分别为89.09%、87.27%、87.50%和88.89%。当（1，3）-β-D葡聚糖≥ 247.95 pg/mL时，用于预测PCP患者预后的敏感度、特异度、阳性预测值、阴性预测值分别为79.17%、93.55%、90.48%和85.29%。结论血浆（1，3）-β-D葡聚糖水平可以作为PCP的一个早期诊断指标，以及用来预测患者的临床预后。

关键词: (1,3)-β-D葡聚糖, 肺孢子菌肺炎, 艾滋病, 诊断, 预后

Abstract: Objective To evaluate the clinical value of level of the plasma(1,3)-β-D-glucan in diagnosis and prognosis of the acquired immune deficiency syndrome(AIDS) patients complicated with Pneumocystis pneumonia(PCP).Methods A retrospective analysis of 110 AIDS patients who were hospitalized to Liuzhou People's Hospital from January 2012 to January 2021, 55 patients who were clinically diagnosed with PCP were assigned as the observationg, while 55 patients with non-opportunistic infections were set as the control group. The observation group was further divided into improvement group (31 cases) and death group (24 cases). The plasma levels of (1,3)-β-D-glucan were compared. The clinical diagnosis and prognosis values of (1,3)-β-D-glucan for PCP AIDS patients with PCP were evaluated by ROC curve.Results (1,3)-β-D-glucan level in control group was lower than that in observation group[9.00(4.00,56.95) pg/mL vs. 182.50(100.60,355.00) pg/mL], improvement group(baseline) was lower than death group(baseline)[115.20(92.40,198.20) pg/mL vs. 360.70(253.50,523.20) pg/mL], improvement group(baseline) was higher than post-treatment (4 weeks) group[115.20(92.40,198.20) pg/mL vs. 34.39(10.00,81.45) pg/mL], death group(baseline) was lower than post-treatment (at death) group[360.70(253.50,523.20) pg/mL vs. 550.90(369.48,631.30) pg/mL]. The positive rate of (1,3)-β-D-glucan in control group was lower than that in observation group[21.82%% vs. 92.73%], the positive rate of (1,3)-β-D-glucan in improvement group(baseline) was higher than that in post-treatment (4 weeks) group[87.10% vs. 25.81%]. When (1,3)-β-D-glucan ≥ 77.65pg/mL,the sensitivity、specificity、positive predictive value and negative value for diagnosis of PCP were 89.09%、87.27%、87.50% and 88.89% respectively. When (1,3)-β-D-glucan ≥ 247.95 pg/mL,the sensitivity、specificity、positive predictive value and negative value for predicting the prognosis of PCP were 79.17%、93.55%、90.48% and 85.29% respectively.Conclusion Plasma (1,3)-β-D-glucan levels can be used as an early diagnostic marker of PCP and to predict the clinical outcome of patients.

Key words: (1,3)-β-D-glucan, Pneumocystis pneumonia, acquired immune deficiency syndrome, diagnose, prognosis

中图分类号:

R 519.8 R 563.1 A

兰慧慧, 陈涛, 蒋忠胜, 李敏基, 覃锦玉, 莫胜林, 蒙达礼, 唐贵. 血浆(1,3)-β-D葡聚糖水平对艾滋病患者合并肺孢子菌肺炎诊断及预后的临床价值[J]. 中国真菌学杂志, 2022, 17(6): 476-481.

LAN Huihui, CHEN Tao, JIANG Zhongsheng, LI Minji, QIN Jinyu, MO Shenglin, MENG Dali, TANG Gui. Clinical value of (1,3)-β-D-glucan levels in diagnosis and prognosis of AIDS patients complicated with Pneumocystis pneumonia[J]. Chinese Journal of Mycology, 2022, 17(6): 476-481.

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