本文選題：支氣管肺泡灌洗液 + 血清�。� 參考：《山東大學》2017年碩士論文

【摘要】：研究目的探討1,3-β-D-葡聚糖檢測(G試驗)及半乳甘露聚糖抗原檢測(GM試驗)對非粒細胞缺乏的侵襲性肺部真菌感染(IPFI)患者早期診斷的意義,以便更好地指導臨床治療。研究方法收集山東省立醫(yī)院呼吸內科2011年1月至2017年03月住院期間疑診IPFI且無粒細胞缺乏史的149位患者的病史資料進行回顧性分析,將52例擬診IPFI,42例臨床診斷IPFI以及12例確診IPFI納入IPFI組,診斷非IPFI的43例為非IPFI組。比較2組血清1,3-β-D-葡聚糖及半乳甘露聚糖水平,并分析血清G/GM試驗診斷IPFI的靈敏度、特異度以及cut off值。亞組研究:收集的149例研究對象中有19例同時檢測了血清和肺泡灌洗液中半乳甘露聚糖水平,將12例擬診、臨床診斷及確診的IPFI患者納入觀察組,7例診斷非IPFI患者納入對照組,比較兩種GM檢測方法在不同界定值下診斷IPFI的靈敏度、特異度、陽性預測值及陰性預測值。結果1)IPFI組血清1,3-β-D-葡聚糖水平相較非IPFI組是明顯高的(P=0.019);診斷IPFI的靈敏度為39.6%,特異度為89.4%,cut off值為152.8 pg/ml。2)IPFI組血清半乳甘露聚糖水平顯著高于非IPFI組(P=0.000);診斷IPFI的靈敏度為52.9%,特異度為77.5%,cut off值為0.4615 ug/L。3)亞組研究:觀察組BALF中半乳甘露聚糖水平與對照組相比,存在顯著性的統(tǒng)計學差異(P=0.000),且顯著高于同組血清半乳甘露聚糖水平(P=0.001)。當GM試驗界值取0.5時,BALF GM診斷IPFI的靈敏度、特異度、PPV 及 NPV 分別是 91.67%,85.71%,91.67%和 85.71%,而血清GM 則分別為 33.33%,57.14%,57.14%和 33.33%。而取 1.0 時,BALF GM試驗除了靈敏度不變外都有提高,分別是91.67%,100%,100%和87.50%,且均高于血清 GM 試驗(25%,85.71%,75%,40%)。結論及意義1)血清G/GM試驗診斷非中性粒細胞缺乏的侵襲性肺真菌感染靈敏度較低,特異度較高,對其早期診斷仍有一定價值。2)初步探究BALF GM試驗對非中性粒細胞缺乏的侵襲性肺真菌感染的診斷意義發(fā)現(xiàn),其靈敏度及特異度均優(yōu)于血清樣本;在界值為1.Oug/L時,其臨床診斷價值可達最佳;但因其為侵入性肺部操作,臨床應用時應注意評估患者情況及避免造成真菌定植的風險。
[Abstract]:Objective to investigate the significance of 1t3- 尾 -Dglucan test (G test) and galactomannan antigen test (GM test) in early diagnosis of invasive pulmonary fungal infection (IPFI) with non-granulocytic deficiency in order to better guide clinical treatment. Methods data of 149 patients with suspected IPFI who had no history of granulocytic deficiency during hospitalization from January 2011 to March 2017 in Department of Respiratory Medicine of Shandong Provincial Hospital were retrospectively analyzed. Forty-two cases of clinically diagnosed IPFI and 12 cases of confirmed IPFI were included in IPFI group. 43 cases of non-IPFI were diagnosed as non-IPFI group. The serum levels of 1t3- 尾 -D- glucan and galactomannan were compared between the two groups, and the sensitivity, specificity and cut off value of serum G/GM test in the diagnosis of IPFI were analyzed. Subgroup study: 19 of 149 subjects were tested for galactomannan levels in both serum and alveolar lavage fluid. 12 patients with IPFI were included in the observation group, and 7 patients with non IPFI were included in the control group. The sensitivity, specificity, positive predictive value and negative predictive value of the two methods for the diagnosis of IPFI were compared. Results the serum level of 1t3- 尾 -D- glucan in 1)IPFI group was significantly higher than that in non-IPFI group (P 0.019), the sensitivity in diagnosis of IPFI was 39.6, the specificity was 89.4 and the off value of 152.8 pg/ml.2)IPFI was significantly higher than that in non-IPFI group, and the sensitivity in the diagnosis of IPFI was 52.9%. The subgroup study on the specificity of 77.5 cut off was 0.4615 ugr / L. 3) subgroup: the level of galactomannan in BALF in the observation group was higher than that in the control group. There was significant statistical difference (P < 0. 000), and it was significantly higher than the serum galactomannan level of the same group (P < 0. 001). When the threshold value of GM test was 0.5, the sensitivity of BALF GM in the diagnosis of IPFI was 91.67% and 85.71%, respectively, and the specificity of NPV was 91.67% and 85.71%, respectively, while the serum GM was 33.333,57.14% and 33.33%, respectively. However, the sensitivity of BALF GM test increased by 91.67% and 87.50%, respectively, and was higher than that of serum GM test. Conclusion and significance 1) the sensitivity and specificity of serum G/GM test in the diagnosis of invasive pulmonary fungal infections with non-neutrophil deficiency were lower and higher. To explore the significance of BALF GM test in the diagnosis of invasive pulmonary fungal infection with non-neutrophil deficiency, the sensitivity and specificity of the test were higher than those of serum samples, and when the threshold value was 1.Oug/L, the sensitivity and specificity of the test were better than those of serum samples. Its clinical diagnostic value is the best, but because it is an invasive pulmonary operation, it should be paid attention to evaluate the patient's condition and avoid the risk of fungal colonization.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R519

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