(1,3)-β-D葡聚糖检测联合CD4+T淋巴细胞计数对AIDS合并侵袭性真菌病的诊断价值

doi:10.3969/j.issn.1673-8640.2015.08.003

检验医学 ›› 2015, Vol. 30 ›› Issue (8): 787-790.DOI: 10.3969/j.issn.1673-8640.2015.08.003

(1,3)-β-D葡聚糖检测联合CD4⁺T淋巴细胞计数对AIDS合并侵袭性真菌病的诊断价值

柳明波, 梁欣, 翁国庆, 姚钦江, 黄素兰, 韦良宏

广西医科大学第十附属医院,广西钦州 535000

收稿日期:2014-08-14 出版日期:2015-08-30 发布日期:2015-08-28
作者简介:null
作者简介:柳明波,男,1979年生,硕士,主管技师,主要从事微生物检验工作。

通讯作者:韦良宏,联系电话:0771-2863337。
基金资助:
广西壮族自治区卫生厅青年基金资助项目(Z2013746)

Significance on the detection of (1,3)-beta-D glucan and CD4⁺T lymphocyte count for the diagnosis of invasive fungal disease in patients with AIDS

LIU Mingbo, LIANG Xin, WENG Guoqing, YAO Qinjiang, HUANG Sulan, WEI Lianghong.

The Tenth Affiliated Hospital of Guangxi Medical University, Guangxi Qinzhou 535000, China

Received:2014-08-14 Online:2015-08-30 Published:2015-08-28

摘要/Abstract

摘要：

目的探讨(1,3)-β-D葡聚糖(BDG)检测(简称G试验)联合CD4⁺T淋巴细胞计数对获得性免疫缺陷综合征(AIDS)合并侵袭性真菌病(IFD)诊断的价值。方法选择2013年1月至2014年5月在广西医科大学第十附属医院感染科住院怀疑合并IFD的AIDS患者297例,治疗前同时行G试验和CD4⁺T淋巴细胞计数。根据IFD的诊断标准将患者分为IFD组(拟诊、临床诊断和确诊)和非IFD组。分析G试验作为IFD诊断方法的敏感性、特异性和G试验联合CD4⁺T淋巴细胞计数的敏感性、特异性。结果 G试验诊断AIDS合并IFD的敏感性为75.3%,特异性为87.4%。根据G试验结果绘制受试者工作特征(ROC)曲线,曲线下面积为0.861(95%可信区间0.720~0.865)。G试验和CD4⁺T淋巴细胞联合检测的敏感性为92.9%,特异性为88.8%。结论 G试验对AIDS合并IFD有较好的诊断价值,G试验联合CD4⁺T淋巴细胞计数可明显提高AIDS合并IFD的临床诊断价值。

关键词: (1, 3)-β-D葡聚糖, CD4+T淋巴细胞计数, 获得性免疫缺陷综合征, 侵袭性真菌病

Abstract:

Objective To investigate the diagnosis significance of the detection of (1,3)-beta-D glucan (BDG) assay(G test) and CD4⁺T lymphocyte count for invasive fungal disease (IFD) in patients with acquired immune deficiency syndrome (AIDS). Methods A total of 297 patients with AIDS from the Tenth Affiliated Hospital of Guangxi Medical University were enrolled from January 2013 to May 2014. They were suspected to suffer from IFD. Before receiving anti-fungal treatment, G test and CD4⁺T lymphocyte count were performed and detected simultaneously. According to the diagnosis standard of IFD, the patients were classified into IFD group (including possible, probable and proven diagnosis) and non-IFD group. G test for diagnosing IFD was analyzed for sensitivity and specificity, respectively. G test and CD4⁺T lymphocyte count were combined to evaluate the diagnosis sensitivity and specificity. Results The sensitivity and specificity of G test for diagnosing IFD in AIDS patients were 75.3% and 87.4%, and the receiver operating characteristic (ROC) curve of G test was analyzed, and the area under the curve was 0.861 (95% confidence interval 0.720-0.865). The sensitivity and specificity were 92.9% and 88.8% in the combined determination of G test and CD4⁺T lymphocyte count. Conclusions G test is useful in the diagnosis of IFD among patients with AIDS, and the clinical application significance is improved when it is combined with CD4⁺T lymphocyte count for diagnosing IFD with AIDS.

Key words: (1, 3)-beta-D glucan, CD4+T lymphocyte count, Acquired immune deficiency syndrome, Invasive fungal disease

中图分类号:

R446.5

柳明波, 梁欣, 翁国庆, 姚钦江, 黄素兰, 韦良宏. (1,3)-β-D葡聚糖检测联合CD4⁺T淋巴细胞计数对AIDS合并侵袭性真菌病的诊断价值[J]. 检验医学, 2015, 30(8): 787-790.

LIU Mingbo, LIANG Xin, WENG Guoqing, YAO Qinjiang, HUANG Sulan, WEI Lianghong.. Significance on the detection of (1,3)-beta-D glucan and CD4⁺T lymphocyte count for the diagnosis of invasive fungal disease in patients with AIDS[J]. Laboratory Medicine, 2015, 30(8): 787-790.

图/表 5

参考文献 10

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病原菌	BDG< 20 pg/mL	BDG≥20 pg/mL
病原菌	BDG< 20 pg/mL	例数	中位数(范围)
念珠菌	0	8	67.52(29.82~772.40)
曲霉	0	1	23.81
新生隐球菌	13	2	15.89(15.53~26.24)
毛霉	0	1	87.63
马尔尼菲青霉	1	26	97.52(18.42~>1 000.00)

病原菌	BDG< 20 pg/mL	BDG≥20 pg/mL
病原菌	BDG< 20 pg/mL	例数	中位数(范围)
念珠菌	0	8	67.52(29.82~772.40)
曲霉	0	1	23.81
新生隐球菌	13	2	15.89(15.53~26.24)
毛霉	0	1	87.63
马尔尼菲青霉	1	26	97.52(18.42~>1 000.00)

组别	例数	CD4⁺T淋巴细胞(cell/μL)
组别	例数	﹥200	100~200	50~99	﹤50
IFD组	154	1	2	33	118
非IFD组	143	93	19	28	3

组别	例数	CD4⁺T淋巴细胞(cell/μL)
组别	例数	﹥200	100~200	50~99	﹤50
IFD组	154	1	2	33	118
非IFD组	143	93	19	28	3

组别	G试验		联合诊断
组别	阳性	阴性	阳性	阴性
IFD组	116(75.3)	38(24.7)	143(92.9)	11(7.1)
非IFD组	18(12.6)	125(87.4)	16(11.2)	127(88.8)

(1,3)-β-D葡聚糖检测联合CD4⁺T淋巴细胞计数对AIDS合并侵袭性真菌病的诊断价值

Significance on the detection of (1,3)-beta-D glucan and CD4⁺T lymphocyte count for the diagnosis of invasive fungal disease in patients with AIDS

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(1,3)-β-D葡聚糖检测联合CD4+T淋巴细胞计数对AIDS合并侵袭性真菌病的诊断价值

Significance on the detection of (1,3)-beta-D glucan and CD4+T lymphocyte count for the diagnosis of invasive fungal disease in patients with AIDS

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(1,3)-β-D葡聚糖检测联合CD4⁺T淋巴细胞计数对AIDS合并侵袭性真菌病的诊断价值

Significance on the detection of (1,3)-beta-D glucan and CD4⁺T lymphocyte count for the diagnosis of invasive fungal disease in patients with AIDS