G试验对肾移植受者侵袭性肺部真菌感染的临床诊断价值

Role of G test in clinical diagnosis of invasive pulmonary fungal infection in kidney transplantation recipients

  • 摘要: 目的 评价血浆(1,3)-β-D葡聚糖定量分析(G试验)对肾移植受者侵袭性肺部真菌感染(invasive pulmonary fungal infection,IPFI)的临床诊断价值。 方法 回顾性分析2008年10月-2013年1月在解放军第309医院住院的肾移植受者127例临床资料,分成IPFI组(24例)和非IPFI组(103例),比较两组血浆(1,3)-β-D葡聚糖含量,并绘制ROC曲线判断G试验对肾移植受者IPFI诊断的最佳临界值。 结果 肾移植受者IPFI组的血浆(1,3)-β-D葡聚糖的中位含量(79.51 pg/m l)明显高于对照组(<10 pg/m l)(P<0.001);当患者CT有新发感染迹象时,G试验用于诊断肾移植受者IPFI的ROC曲线下面积为0.795,最佳临界值为13.08 pg/m l,灵敏度、特异度、阳性预告值、阴性预告值分别为0.778、0.861、0.737、0.882;当患者CT无新发感染迹象时,其ROC曲线下面积为0.897,最佳临界值为38.65 pg/ml,灵敏度、特异度、阳性预告值、阴性预告值分别为0.833、0.940、0.556、0.984。 结论 G试验早期诊断肾移植受者IPFI简便、有效;患者CT有无新发感染迹象时,G试验诊断肾移植受者IPFI的最佳临界值分别为13.08pg/m l、38.65pg/m l。

     

    Abstract: Objective To assess the role of G test in clinical diagnosis of invasive pulmonary fungal infection (IPFI) in kidney transplantation recipients. Methods Clinical data about 127 kidney transplantation recipients admitted to Chinese PLA 309 Hospital from October 2008 to January 2013 were retrospectively analyzed. The patients were divided into IPFI group (n=24) and non-IPFI group (n=103). Their plasma (1, 3)-β-D glucan levels were measured. ROC curves were plotted for the diagnosis of IPFI in kidney transplantation recipients. Results The mean plasma (1, 3)-β-D glucan level was significantly higher in IPFI group than in non-IPFI group (79.51 pg/ml vs 10 pg/ml, P<0.001). G test showed that the area under the ROC curves was 0.795 and the optimal threshold value was 13.08 pg/ml for the diagnosis of IPFI in kidney transplantation recipients when CT demonstrated new infections, with a sensitivity of 0.778, a specificity of 0.861, a positive prediction value of 0.737, and a negative prediction value of 0.882. G test showed that the area under the ROC curves was 0.897 and the optimal threshold value was 13.08 pg/ml for the diagnosis of IPFI in kidney transplantation recipients when CT displayed no new infections, with a sensitivity of 0.833, a specificity of 0.940, a positive prediction value of 0.556, and a negative prediction value of 0.984. Conclusion G test is simple and effective for the diagnosis of IPFI in kidney transplantation recipients with an optimal threshold value of 13.08 pg/ml and 38.65 pg/ml, respectively, when CT shows no new infections.

     

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