Qian Ke-Yu, Lyu Quan-Xing, Dai Li-Jun, Chang Hui-Rong, Wu De-Pei, Sun Ai-Ning
Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University; Key Laberatory of Thrombosis and Hemostasis, Ministry of Health, Suzhou 215006, Jiangsu Province, China.
Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University; Key Laberatory of Thrombosis and Hemostasis, Ministry of Health, Suzhou 215006, Jiangsu Province, China E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2019 Oct;27(5):1678-1681. doi: 10.19746/j.cnki.issn.1009-2137.2019.05.049.
To analyze the diagnostic value of (1, 3) -β-D-glucan and galactomannan (GM) tests in the patients with acute leukemia complicated by invasive fungal disease, and explore the application of serological detection (G/GM) and lung CT for early diagnosis of invasive fungal disease (IFD).
A total of 493 patients with acute leukemia complicated by high risk invasive fungal infection, also receival G and GM tests, in Department of hematology of our hospital from June 2016 to December 2016 were selected and were divided into IFD-confirmed group (62 cases) including confirmed and clinical diagnesed IFD, and IFD-unconfirmed group (431 cases) including suspected IFD and non-IFD according to the diagnostic criteria of IFD. The results of G and GM tests in patients of 2 groups were analyzed, then the diagnostic efficacy of G and GM done and combination evaluated. In addition, 26 patients whose lung CT negative at hospitalization, moreover, presentation of changes in lung by CT during hospitalization and serological G and GM test positive were selected, and the difference of time between serological that postive and presentation of changes in lung by CT were compared for the estimation of early diagnotic value.
The positive rate of (1, 3) -β-D-glucan in IFD-confirmed group and IFD-unconfirmed group was 56.5% and 10.4%, respectively. Meanwhile, that of galactomannan test was 41.9% and 9.0%, respectively. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of (1, 3) -β-D-glucan was 56%, 90%, 44% and 92%, and that of galactomannan was 42%、91%、40% and 93%, respectively. Moreover, the combination of (1, 3) -β-D-glucan and galactomannan could raise the sensitivity to 69% and specificity to 98%. The positive results of serological detection (G/GM) come earlier about five days than CT changes.
Both (1, 3) -β-D-glucan and galactomannan test have high sensitivity and specificity, and the combination of them can improve the diagnostic efficacy, and make the clinical antifungal therapy more precisely. In the early clinical diagnosis of IFD, the positive results of serological detection coming earlier than lung CT.
分析（1,3）-β-D-葡聚糖（G）和半乳甘露聚糖（GM）检测对急性白血病合并侵袭性真菌病患者的诊断价值，探讨血清学检测（G/GM）和肺部CT在侵袭性真菌病（IFD）早期诊断中的应用。
选取2016年6月至2016年12月我院血液科收治的493例急性白血病合并高危侵袭性真菌感染且接受G和GM检测的患者，根据IFD诊断标准分为IFD确诊组（62例，包括确诊和临床诊断的IFD）和IFD未确诊组（431例，包括疑似IFD和非IFD）。分析两组患者G和GM检测结果，评估G、GM及两者联合检测的诊断效能。此外，选取26例住院时肺部CT阴性、住院期间肺部CT出现变化且血清学G和GM检测阳性的患者，比较血清学阳性与肺部CT出现变化的时间差，以评估早期诊断价值。
IFD确诊组和IFD未确诊组（1,3）-β-D-葡聚糖的阳性率分别为56.5%和10.4%。同时，半乳甘露聚糖检测的阳性率分别为41.9%和9.0%。（1,3）-β-D-葡聚糖的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为56%、90%、44%和92%，半乳甘露聚糖的分别为42%、91%、40%和93%。此外，（1,3）-β-D-葡聚糖和半乳甘露聚糖联合检测可使敏感性提高至69%，特异性提高至98%。血清学检测（G/GM）阳性结果比CT变化提前约5天出现。
（1,3）-β-D-葡聚糖和半乳甘露聚糖检测均具有较高的敏感性和特异性，两者联合可提高诊断效能，使临床抗真菌治疗更精准。在IFD的早期临床诊断中，血清学检测阳性结果早于肺部CT。
