血浆(1-3)-β-D葡聚糖检测对真菌血流感染的诊断价值
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摘要
目的探讨血浆(1-3)-β-D葡聚糖检测(G试验)对真菌血流感染的诊断价值。方法收集海军军医大学(第二军医大学)长海医院2015年1月至2017年12月临床各科室送检的进行真菌血培养和G试验的血液标本。分析264例真菌血培养阳性标本的来源科室分布和菌种分布情况。1 678例同时进行真菌血培养和G试验,以真菌血培养阳性为标准,G试验结果>100.5 pg/mL为阳性,计算G试验诊断真菌血流感染的灵敏度、特异度、阳性预测值、阴性预测值;采用SPSS 19.0软件进行统计学分析,以受试者工作特征(ROC)曲线评估G试验对真菌血流感染的诊断价值。结果 2015—2017年共检出血培养阳性真菌264株,主要分布在肝胆外科(81株)、心血管外科(57株)、急救科(24株)、胸外科(22株)、血液科(16株)等科室;病原菌以假丝酵母菌属为主,其中近平滑假丝酵母菌最多(142株,占53.8%),其次为角膜假丝酵母菌(36株,13.6%)、白假丝酵母菌(20株,7.6%)和热带假丝酵母菌(18株,6.8%)。1 678例同时进行真菌血培养和G试验的患者中,137例真菌血培养结果为阳性。以真菌血培养阳性为标准,G试验诊断真菌血流感染的灵敏度、特异度、阳性预测值、阴性预测值分别为61.3%、87.9%、31.1%、96.2%;ROC曲线分析结果显示,G试验对真菌血流感染的诊断效能较好(曲线下面积为0.771,95%置信区间为0.723～0.819)。137例真菌血流感染病例中,102例在血培养之前2～5 d进行了G试验,其中71例(69.6%)G试验结果为阳性。结论血浆G试验诊断真菌血流感染的特异度较高,对真菌血流感染的早期诊断具有较好的阴性预测价值。
Objective To investigate the clinical value of plasma(1-3)-β-D-glucan test(G test) for diagnosis of fungal bloodstream infection. Methods The blood samples for fungal culturing and G test were collected in Changhai Hospital of Naval Medical University(Second Military Medical University) from Jan. 2015 to Dec. 2017. The department distribution and strain distribution of 264 positive specimens detected by fungal blood culture were analyzed. A total of1 678 samples were collected during this period for fungal blood culture and plasma G test. Taking fungal blood culture as the criterion, with a cut-off of 100.5 pg/mL for G test, we analyzed the sensitivity, specificity, positive forecast value, and negative forecast value of G test for diagnosis of fungal bloodstream infection. Statistical analysis was performed using SPSS 19.0 software, and the diagnostic value of G test for bloodstream infection was judged by the receiver operating characteristic(ROC)curve. Results A total of 264 strains of fungal blood culture were positive from 2015 to 2017, mainly from the departments of hepatobiliary surgery(81 strains), cardiac surgery(57 strains), emergency(24 strains), thoracic surgery(22 strains), and hematology(16 strains). Candida is the main genus, of which Candida parapsilosis is the most common one, with 142 strains(53.8%), followed by Candida corneum(36 stains, 13.6%), Candida albicans(20 strains, 7.6%) and Candida tropical(18 strains, 6.8%). Taking fungal blood culture as the criterion, we found that the sensitivity, specificity, positive forecast value, and negative forecast value of G test for diagnosis of fungal infection were 61.3%, 87.9%, 31.1%, and 96.2%,respectively. ROC curve analysis showed that G test was valuable for diagnosis of fungal bloodstream infection, with the area under the curve being 0.771(95% confidence interval: 0.723-0.819). Among 137 cases of bloodstream infection, 102 cases(69.6%) were tested for G test 2-5 d before blood culture, and 71 cases were positive. Conclusion Plasma G test kit is still ideal in terms of specificity and has a certain clinical value for the early diagnosis of fungal bloodstream infection.
Objective To investigate the clinical value of plasma(1-3)-β-D-glucan test(G test) for diagnosis of fungal bloodstream infection. Methods The blood samples for fungal culturing and G test were collected in Changhai Hospital of Naval Medical University(Second Military Medical University) from Jan. 2015 to Dec. 2017. The department distribution and strain distribution of 264 positive specimens detected by fungal blood culture were analyzed. A total of1 678 samples were collected during this period for fungal blood culture and plasma G test. Taking fungal blood culture as the criterion, with a cut-off of 100.5 pg/mL for G test, we analyzed the sensitivity, specificity, positive forecast value, and negative forecast value of G test for diagnosis of fungal bloodstream infection. Statistical analysis was performed using SPSS 19.0 software, and the diagnostic value of G test for bloodstream infection was judged by the receiver operating characteristic(ROC)curve. Results A total of 264 strains of fungal blood culture were positive from 2015 to 2017, mainly from the departments of hepatobiliary surgery(81 strains), cardiac surgery(57 strains), emergency(24 strains), thoracic surgery(22 strains), and hematology(16 strains). Candida is the main genus, of which Candida parapsilosis is the most common one, with 142 strains(53.8%), followed by Candida corneum(36 stains, 13.6%), Candida albicans(20 strains, 7.6%) and Candida tropical(18 strains, 6.8%). Taking fungal blood culture as the criterion, we found that the sensitivity, specificity, positive forecast value, and negative forecast value of G test for diagnosis of fungal infection were 61.3%, 87.9%, 31.1%, and 96.2%,respectively. ROC curve analysis showed that G test was valuable for diagnosis of fungal bloodstream infection, with the area under the curve being 0.771(95% confidence interval: 0.723-0.819). Among 137 cases of bloodstream infection, 102 cases(69.6%) were tested for G test 2-5 d before blood culture, and 71 cases were positive. Conclusion Plasma G test kit is still ideal in terms of specificity and has a certain clinical value for the early diagnosis of fungal bloodstream infection.
引文
[1]ESCRIBANO P,RODRíGUEZ-CRéIXEMS M,SáNCHEZ-CARRILLO C,MU?OZ P,BOUZA E,GUINEA J.Endemic genotypes of Candida albicans causing fungemia are frequent in the hospital[J].J Clin Microbiol,2013,51:2118-2123.
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[6]左向华,陈建魁,于农,金欣,尹秀云,宋世平,等.侵袭性真菌感染患者1,3-β-D葡聚糖检测的临床价值[J].国际检验医学杂志,2010,31:220-221,223.
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[8]刘云,黄晓春,万玉香,马炜,李亚周,秦琴.临床真菌血流感染的菌株分布及耐药性分析[J].现代检验医学杂志,2018,33:81-82,86.
[9]GARNACHO-MONTERO J,DíAZ-MARTíN A,GARCíA-CABRERA E,RUIZ PéREZ DE PIPAóN M,HERNáNDEZ-CABALLERO C,LEPE-JIMéNEZ JA.Impact on hospital mortality of catheter removal and adequate antifungal therapy in Candida spp.bloodstream infections[J].J Antimicrob Chemother,2013,68:206-213.
[10]LIU Y,KANG M,YE H,ZONG Z,LV X.Analysis on clinical characteristics and drug resistance of Candida parapsilosis bloodstream infections in West China Hospital,China,from 2012 to 2015[J].J Mycol Med,2018,28:222-226.
[11]KEDZIERSKA A,KOCHAN P,PIETRZYK A,KEDZIERSKA J.Current status of fungal cell wall components in the immunodiagnostics of invasive fungal infections in humans:galactomannan,mannan and(1→3)-β-D-glucan antigens[J].Eur J Clin Microbiol Infect Dis,2007,26:755-766.
[12]张鹏,李小宁,欧成举.血浆(1-3)-β-D葡聚糖检测对真菌感染的诊断价值[J].检验医学与临床,2012,9:564-565.
[13]FARAGGI D,REISER B.Estimation of the area under the ROC curve[J].Stat Med,2002,21:3093-3106.
[14]ACOSTA J,CATALAN M,DEL PALACIO-PERéZ-MEDEL A,LORA D,MONTEJO J C,CUETARA MS,et al.A prospective comparison of galactomannan in bronchoalveolar lavage fluid for the diagnosis of pulmonary invasive aspergillosis in medical patients under intensive care:comparison with the diagnostic performance of galactomannan and of(1→3)-β-D-glucan chromogenic assay in serum samples[J].Clin Microbiol Infect,2011,17:1053-1060.
[15]PERSAT F,RANQUE S,DEROUIN F,MICHEL-NGUYEN A,PICOT S,SULAHIAN A.Contribution of the(1→3)-β-D-glucan assay for diagnosis of invasive fungal infections[J].J Clin Microbiol,2008,46:1009-1013.
[16]宋敏,向成玉,杨葵,吴泽才,林雁.血浆1-3-β-D葡聚糖早期诊断深部真菌感染的临床价值[J/CD].中华临床医师杂志(电子版),2015,9:3445-3447.
[17]曾文新,黄园,邓郁,温妙云,韩永丽,钟文宏,等.真菌(1,3)-β-D葡聚糖检测在重症肺炎患者中真菌检测的临床价值[J].中华急诊医学杂志,2016,25:659-662.
[18]CUENCA-ESTRELLA M,VERWEIJ P E,ARENDRUPM C,ARIKAN-AKDAGLI S,BILLE J,DONNELLY J P,et al;ESCMID Fungal Infection Study Group.ESCMID*guideline for the diagnosis and management of Candida diseases 2012:diagnostic procedures[J].Clin Microbiol Infect,2012,18(Suppl 7):9-18.
[19]PAPPAS P G,KAUFFMAN C A,ANDES D R,CLANCY C J,MARR K A,OSTROSKY-ZEICHNERL,et al.Clinical practice guideline for the management of candidiasis:2016 update by the Infectious Diseases Society of America[J/OL].Clin Infect Dis,2016,62:e1-50.doi:10.1093/cid/civ933.
[20]吴真,徐晓刚.深部真菌病的实验诊断进展[J].中国感染与化疗杂志,2014,14:82-85.
[21]刘春玉,王红,任爱民,杜琨,胡岚,李世荣,等.血浆(1-3)-β-D葡聚糖诊断深部真菌感染的临床研究[J].中国真菌学杂志,2012,7:207-210.
[2]文艳,刘爱胜,张勇,李伟.ICU危重病患者深部真菌感染血清中降钙素原和(1,3)-β-D葡聚糖联合检测的临床意义[J].现代检验医学杂志,2015,30:120-122.
[3]LI D,ZHANG W,ZHENG S,MA Z,ZHANG P,LIU Z.Surveillance study of candidemia in cancer patients in North China[J].Med Mycol,2013,51:378-384.
[4]ARIAS S,DENIS O,MONTESINOS I,CHERIFI S,MIENDJE DEYI V Y,ZECH F.Epidemiology and mortality of candidemia both related and unrelated to the central venous catheter:a retrospective cohort study[J].Eur J Clin Microbiol Infect Dis,2017,36:501-507.
[5]张建芳,徐修礼,樊新,孙怡群.深部真菌感染患者血浆1-3-β-D葡聚糖检测的临床意义[J].中华医院感染学杂志,2005,15:354-355.
[6]左向华,陈建魁,于农,金欣,尹秀云,宋世平,等.侵袭性真菌感染患者1,3-β-D葡聚糖检测的临床价值[J].国际检验医学杂志,2010,31:220-221,223.
[7]周道银,倪语星,王明贵.血流感染实验诊断与临床诊治[M].上海:上海科学技术出版社,2011:6-7.
[8]刘云,黄晓春,万玉香,马炜,李亚周,秦琴.临床真菌血流感染的菌株分布及耐药性分析[J].现代检验医学杂志,2018,33:81-82,86.
[9]GARNACHO-MONTERO J,DíAZ-MARTíN A,GARCíA-CABRERA E,RUIZ PéREZ DE PIPAóN M,HERNáNDEZ-CABALLERO C,LEPE-JIMéNEZ JA.Impact on hospital mortality of catheter removal and adequate antifungal therapy in Candida spp.bloodstream infections[J].J Antimicrob Chemother,2013,68:206-213.
[10]LIU Y,KANG M,YE H,ZONG Z,LV X.Analysis on clinical characteristics and drug resistance of Candida parapsilosis bloodstream infections in West China Hospital,China,from 2012 to 2015[J].J Mycol Med,2018,28:222-226.
[11]KEDZIERSKA A,KOCHAN P,PIETRZYK A,KEDZIERSKA J.Current status of fungal cell wall components in the immunodiagnostics of invasive fungal infections in humans:galactomannan,mannan and(1→3)-β-D-glucan antigens[J].Eur J Clin Microbiol Infect Dis,2007,26:755-766.
[12]张鹏,李小宁,欧成举.血浆(1-3)-β-D葡聚糖检测对真菌感染的诊断价值[J].检验医学与临床,2012,9:564-565.
[13]FARAGGI D,REISER B.Estimation of the area under the ROC curve[J].Stat Med,2002,21:3093-3106.
[14]ACOSTA J,CATALAN M,DEL PALACIO-PERéZ-MEDEL A,LORA D,MONTEJO J C,CUETARA MS,et al.A prospective comparison of galactomannan in bronchoalveolar lavage fluid for the diagnosis of pulmonary invasive aspergillosis in medical patients under intensive care:comparison with the diagnostic performance of galactomannan and of(1→3)-β-D-glucan chromogenic assay in serum samples[J].Clin Microbiol Infect,2011,17:1053-1060.
[15]PERSAT F,RANQUE S,DEROUIN F,MICHEL-NGUYEN A,PICOT S,SULAHIAN A.Contribution of the(1→3)-β-D-glucan assay for diagnosis of invasive fungal infections[J].J Clin Microbiol,2008,46:1009-1013.
[16]宋敏,向成玉,杨葵,吴泽才,林雁.血浆1-3-β-D葡聚糖早期诊断深部真菌感染的临床价值[J/CD].中华临床医师杂志(电子版),2015,9:3445-3447.
[17]曾文新,黄园,邓郁,温妙云,韩永丽,钟文宏,等.真菌(1,3)-β-D葡聚糖检测在重症肺炎患者中真菌检测的临床价值[J].中华急诊医学杂志,2016,25:659-662.
[18]CUENCA-ESTRELLA M,VERWEIJ P E,ARENDRUPM C,ARIKAN-AKDAGLI S,BILLE J,DONNELLY J P,et al;ESCMID Fungal Infection Study Group.ESCMID*guideline for the diagnosis and management of Candida diseases 2012:diagnostic procedures[J].Clin Microbiol Infect,2012,18(Suppl 7):9-18.
[19]PAPPAS P G,KAUFFMAN C A,ANDES D R,CLANCY C J,MARR K A,OSTROSKY-ZEICHNERL,et al.Clinical practice guideline for the management of candidiasis:2016 update by the Infectious Diseases Society of America[J/OL].Clin Infect Dis,2016,62:e1-50.doi:10.1093/cid/civ933.
[20]吴真,徐晓刚.深部真菌病的实验诊断进展[J].中国感染与化疗杂志,2014,14:82-85.
[21]刘春玉,王红,任爱民,杜琨,胡岚,李世荣,等.血浆(1-3)-β-D葡聚糖诊断深部真菌感染的临床研究[J].中国真菌学杂志,2012,7:207-210.
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