G试验、GM试验对侵袭性肺部真菌感染诊断价值的探小学音乐论文
讨
研究生王和庆小拇指关节疼
导师邵润霞
郑州大学第二临床学院呼吸与危重症医学科
河南郑州450014
摘要
研究背景
随着现代医学的迅速发展，侵袭性肺部真菌感染（Invasive pulmonary fungal infection IPFI）的发生率也随之增加，且其死亡率较高，早期诊断仍然是临床医生面临的巨大挑战。泛真菌细胞壁多糖（1-3）-β-D-葡聚糖（(1-3)-β-D-glucan BG）和曲霉菌特异性抗原半乳甘露聚糖（galactomannan GM）已被广泛研究并被纳入国内外IPFI诊断的微生物学标准。然而，关于BG和GM诊断准确性的研究显示了不同的大骗局
结果。此外，BG和GM的临床应用部分受到假阳性和假阴性结果的限制。已经有大量研究评估了BG和GM对IPFI的诊断性能，但是，对于如何在临床实践中应用这些标记物仍然没有达成共识。
目的
探讨G试验、GM试验对IPFI的诊断价值。
方法
（1）回顾性分析2015年1月至2018年12月因肺部感染收住郑州大学第二附属医院呼吸内科病房的患者224例。收集全部患者的基本资料、临床诊断和辅助检查结果。
（2）依据我国IPFI工作组制订的《IPFI的诊断标准与治疗原则》，将患者分为IPFI组（3个诊断级别，确诊、临床诊断、拟诊，本研究IPFI组排除拟诊病例）与NO-IPFI组。IPFI组依据病原学培养结果分为曲霉菌、其他真菌感染两个
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卢克安亚组。
（3）分别计算G试验在IPFI组及肺部曲霉菌感染亚组的灵敏度、特异度、阳性预测值（positive predictive value PPV）、阴性预测值（negative predictive value NPV），并评价G试验对IPFI的诊断价值；分别计算血清、支气管肺泡灌洗液（Bronchoalveolar lavage fluid BALF）GM试验在肺部曲霉菌感染亚组的灵敏度、特异度、PPV、NPV，并比较G试验、GM试验对肺部曲霉菌感染的诊断价值，同时比较血清、BALF GM试验对肺部曲霉菌感染的诊断价值。
（4）收集IPFI组112例患者所有标本的真菌培养结果，分析曲霉菌培养与G 试验、GM试验的一致率及曲霉菌培养对肺部曲霉菌感染的临床诊断价值。
（5）比较IPFI组与NO-IPFI组患者的性别、年龄、住院时间、合并的慢性基础疾病等相关资料，评价IPFI的危险因素。
结果
（1）以BG检测值大于或等于100 pg/mL为G试验阳性，G试验在IPFI组的灵敏度、特异度、PPV、NPV分别为75.00%、78.57%、77.78%、75.86%；G 试验在肺部曲霉菌感染亚组的灵敏度、特异度、PPV、NPV分别为77.27%、26.47%、40.48%、64.29%。以GM试验检测值大于或等于0.50 S/CO为GM试验阳性，GM试验在肺部曲霉菌感染亚组的灵敏度、特异度、PPV、NPV分别为63.64%、76.47%、63.64%、76.47%；BALF GM试验在肺部曲霉菌感染的灵敏度、特异度、PPV、
NPV分别为72.73%、70.59%、61.54%、80.00%。在肺部曲霉菌感染亚组患者中，G试验的灵敏度高于GM试验，G试验、GM试验的灵敏度低于两者联合检测；BALF GM试验的灵敏度高于血清GM试验。普陀加点
（2）G试验受试者工作特征曲线（Receiver operating characteristic curve ROC曲线）曲线下面积（Noarea under the curve AUC）大于GM试验（0.862>0.610）；BALF GM试验ROC曲线下面积大于血清GM试验（0.850>0.735）。
（3）曲霉菌培养阳性中G试验阳性率为77.27%；G试验阳性的IPFI组患者中，曲霉菌培养阳性率为40.48%。曲霉菌培养阳性中GM试验阳性率为63.64%；GM试验阳性的IPFI组患者中，曲霉菌培养阳性率为77.27%。
（4）性别、年龄在IPFI组与NO-IPFI组患者对比分析中P﹥0.05，无统计学意义。而住院时间在两组对比分析中P﹤0.05，有统计学意义，说明IPFI组患者比NO-IPFI组患者住院时间更长。合并的慢性阻塞性肺疾病（Chronic
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obstructive pulmonary dia COPD）、支气管扩张、脑梗塞、高血压、冠心病等慢性基础疾病在
两组对比分析中P﹥0.05，无统计学意义；而肺结核、糖尿病、恶性肿瘤、自身免疫性疾病、肾脏疾病、慢性肝脏疾病等慢性基础疾病在两组对比分析中P﹤0.05，有统计学意义，说明是IPFI的危险因素。
结论
（1）在诊断IPFI时，G试验的价值优于GM试验。
（2）对于IPFI，感染的病原菌以曲霉菌为主，G试验具有较高的敏感性，GM试验具有较高的特异性，两者联合检测，可以降低漏诊率及误诊率。
（3）在诊断肺部曲霉菌感染时，BALF GM试验的价值优于血清GM试验，为防止漏诊及过度诊疗，可依据ROC曲线确定其最佳临界值。
vb实训总结（4）IPFI组比NO-IPFI组住院时间更长，合并有肺结核、糖尿病、恶性肿瘤、自身免疫性疾病、肾脏疾病、慢性肝脏疾病等慢性基础疾病的患者更易发生IPFI，是IPFI的高危因素。
关键词
（1-3）-β-D-葡聚糖，半乳甘露聚糖，侵袭性肺部真菌感染，阳性预测值，阴性预测值。
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海底两万里读后感400字
Discussion on the diagnostic value of G test and GM test for Invasive pulmonary fungal infection
Postgraduate Heqing Wang
Supervisor Runxia Shao
Department of Respiratory and Critical Care Medicine
The Second Clinical College of Zhengzhou University
Henan Zhengzhou 450014
Abstract
Background
With the rapid development of modern medicine, the incidence of Invasive Pulmonary fungal infection (IPFI) is also increasing, and its mortality rate is high, early diagnosis is still a huge challenge for clinicians. The pancreatic fungal cell wall polysaccharide (1-3)-β-D-glucan (BG) and th
e Aspergillus-specific antigen galactomannan (GM) have been extensively studied and incorporated into the microorganisms diagnod by invasive pulmonary fungal infections at home and abroad. However, studies on the diagnostic accuracy of BG and GM show different results. In addition, the clinical application of BG and GM is partially limited by fal positive and fal negative results. A number of studies have evaluated the diagnostic performance of BG and GM for invasive pulmonary fungal infections, but there is still no connsus on how to apply the markers in clinical practice.
Objective
To explore the diagnostic value of G test and GM test for IPFI.
Methods
(1)A retrospective analysis of 224 patients admitted to the respiratory ward of the Second Affiliated Hospital of Zhengzhou University from January 2015 to
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December 2018 due to pulmonary infection. Collect basic data, clinical diagnosis, and auxiliary examination results for all patients.
(2)According to the "Diagnostic Criteria and Treatment Principles of IPFI" formulated by the Working Group on IPFI in China,t he patients were divided into IPFI group (3 diagnostic grades, confirmed diagnosis, clinical diagnosis, suspicious diagnosis, IPFI group excluded the suspicious diagnosis) and NO-IPFI group.The IPFI group was divided into two subgroups of Aspergillus and other fungal infections bad on the results of pathogenic culture.
(3)The nsitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of the G test in the IPFI group and the lung subgroup of pulmonary Aspergillus infection were calculated, and evaluate the diagnostic value of the G test for IPFI. The nsitivity, specificity, PPV and NPV of the rum and BALF GM test in the subgroup of Aspergillus pulmonary infection were calculated parately, and the diagnostic value of G test and GM test for pulmonary Aspergillus infection was compared. At the same time, the diagnostic value of rum and BALF GM test for pulmonary aspergillosis infection was compared.
(4)Collecting fungal culture results of all specimens from 112 patients in the IPFI group, a nalyze the coincidence rate of Aspergillus culture with G test, GM test and the clinical diagnostic value of Aspergillus culture for pulmonary Aspergillus infection.
(5)Compare the gender, age, hospitalization time, combined chronic basic dias and other related data of patients in the IPFI group and the NO-PFI group, and evaluate the risk factors of IPFI.
Results
(1)The G test is positive if the BG test value is greater than or equal to 100 pg/mL, and the nsitivity, specificity, PPV and NPV of the G test in the IPFI group were 75.00%, 78.57%, 77.78%, and 75.86%, respectively; t he nsitivity, specificity, PPV and NPV of the G test in the subgroup of pulmonary Aspergillus infection were 77.27%, 26.47%, 40.48%, and 64.29%. The nsitivity, specificity, PPV and NPV of the GM test in the subgroup of Aspergillus infection of the lung were 63.64%, 76.47%, 63.64%, and 76.47%, respectively, when the GM test value was greater than
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