目的 探讨血清(1,3)-β-D葡聚糖检测(G试验)联合尿真菌培养对泌尿系侵袭性真菌感染(invasive fungal infection,IFI)诊断效能的影响。方法 选取2019-05至2020-10武警特色医学中心收治的疑似泌尿系IFI患者135例为研究对象,采集所有患者血清及清洁中段尿标本。采用MB-80微生物快速动态检测系统进行血清G试验,并进行尿真菌培养,以患者临床症状、影像学诊断、抗菌药物使用情况及相应症状转归情况作为诊断IFI的诊断标准,统计G试验、尿真菌培养检测结果,分析二者单独或联合诊断的灵敏度、特异度、准确度。结果 本组共135例疑似泌尿系IFI患者,经临床综合诊断确诊为泌尿系IFI患者52例;尿真菌培养检出泌尿系IFI阳性63例;G试验检出泌尿系IFI阳性64例;G试验联合尿真菌培养检出泌尿系IFI阳性43例。尿真菌培养共检出真菌63株,假丝酵母菌属61例,其中白假丝酵母菌最多,共45例(71.43%);2例为曲霉菌属。G试验联合尿真菌培养诊断泌尿系IFI的灵敏度[80.77%(42/52)]、阴性预测值(negative predictive value,NPV)[89.13%(82/92)]与二者单独诊断对比差异无统计学意义;G试验联合尿真菌培养诊断泌尿系IFI的特异度[98.80%(82/83)]、准确度[91.85%(124/135)]、阳性预测值(positive predictive value,PPV)[97.67%(42/43)]、约登(Youden)指数(0.796)均高于二者单独诊断,差异有统计学意义(P＜0.05)。结论 临床诊断泌尿系IFI时采用G试验联合尿真菌培养,能提高诊断特异度、准确度及阳性预测值。
Abstract
Objective To study the effect of (1, 3) - beta-D glucan detection (G test) combined with urinary fungal culture on the diagnostic efficacy of invasive fungal infection (IFI) in the urinary system. Methods One hundred and thirty-five suspected cases of urinary IFI treated in our hospital between May 2019 and October 2020 were selected as the subjects. Serum samples and clean urine samples were collected from each of the patients. Serum G test was conducted via the MB-80 microbial rapid dynamic detection system and urinary fungi culture was carried out. Clinical symptoms, imaging diagnosis, use of antibiotics and prognosis of corresponding symptoms were used as the diagnostic criteria for IFI. The results of G test and urinary fungus culture test were recorded, and the sensitivity, specificity and accuracy of the two diagnostic methods used alone or in combination were analyzed. Results A total of 135 suspected urinary IFI patients were diagnosed with urinary IFI, 52 of whom were diagnosed with urinary IFI. Among these patients, 63 were urinary IFI positive by fungal culture and 64 by G test. 43 were urinary IFI positive by G test combined with fungal culture. A total of 63 strains of fungi were detected in urinary fungi culture, and the dominating one was Candida albicans that accounted for 71.43% (45/63). The sensitivity of G test combined with urinary fungi culture in diagnosing urinary IFI [80.77% (42/52)] and NPV [89.13% (82/92)] was not significantly different from that of the two diagnostic methods when used alone (P>0.05). The specificity, accuracy and PPV of G test combined with urinary fungi culture in diagnosing urinary IFI were [98.80% (82/83)] [91.85% (124/135)]and [97.67% (42/43)]respectively. The Youden index (0.796) was higher than when the two diagnostic methods were used alone (P＜0.05). Conclusions Candida albicans is the main pathogenic fungus of urinary IFI. G test combined with urinary fungus culture in clinical diagnosis of urinary IFI can significantly improve the diagnostic specificity, accuracy and positive predictive value.
关键词
泌尿系 /
侵袭性真菌感染 /
G试验 /
真菌培养 /
诊断效能
Key words
the urinary system /
invasive fungal infection /
G test /
fungal culture /
diagnostic efficacy
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