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目的评价1,3-β-D-葡聚糖检测(G试验)对自身免疫性疾病合并侵袭性肺真菌的诊断价值。方法回顾性研究郑州大学第一附属医院2014年1月至2016年1月临床诊断为自身免疫性疾病,在免疫抑制治疗过程中合并肺部感染的住院患者372例,根据侵袭性肺部真菌感染的诊断标准和治疗原则(草案)(其中G试验不作为诊断标准),分为自身免疫性疾病合并侵袭性肺真菌及自身免疫性疾病合并非侵袭性肺真菌病。自身免疫性疾病合并侵袭性肺真菌病患者分为:确诊(18例),临床诊断(35例),拟诊(70例),将确诊和临床诊断患者作为病例组(53例),自身免疫性疾病合并非侵袭性肺真菌患者作为对照组(249例),分析两组1,3-β-D-葡聚糖的水平及对自身免疫性疾病合并侵袭性肺真菌病的诊断价值。结果自身免疫性疾病合并侵袭性肺真菌患者的1,3-β-D-葡聚糖水平明显高于自身免疫性疾病合并非侵袭性肺真菌患者(P<0.05)。应用受试者工作特征(ROC)曲线进行分析发现G试验对自身免疫性疾病合并侵袭肺真菌患者具有较高的诊断价值(ROC曲线下面积为0.83),在1,3-β-D-葡聚糖=93.8 pg/ml时其诊断的敏感性、特异性、阳性预测值、阴性预测值分别为0.65(95%置信区间0.56~0.73)、0.87(95%置信区间0.83~0.92)、0.70(95%置信区间0.64~0.81)、0.83(95%置信区间0.79~0.88)。结论 G试验对自身免疫性疾病合并侵袭性肺真菌病的诊断具有重要价值。
Objective To evaluate the diagnostic value of 1,3-β-D-glucan (G test) in the diagnosis of autoimmune diseases associated with invasive pulmonary fungi. Methods A retrospective study of the first Affiliated Hospital of Zhengzhou University January 2014 to January 2016 clinically diagnosed as autoimmune diseases, immunosuppressive therapy in patients with pulmonary infection in 372 cases of hospitalized patients, according to invasive pulmonary fungal infection Of the diagnostic criteria and principles of treatment (draft) (G test not as a diagnostic criteria), is divided into autoimmune diseases combined with invasive pulmonary fungal and autoimmune diseases with non-invasive pulmonary mycosis. Patients with autoimmune disease complicated with invasive pulmonary mycosis were diagnosed (18 cases), clinical diagnosis (35 cases) and suspected diagnosis (70 cases). Patients diagnosed and clinically diagnosed as cases (53 cases), autoimmune The patients with non-invasive pulmonary fungal disease were selected as the control group (249 cases). The levels of 1,3-β-D-glucan and the diagnostic value of autoimmune diseases with invasive pulmonary mycosis were analyzed. Results The levels of 1,3-β-D-glucan in patients with autoimmune diseases complicated with invasive pulmonary fungi were significantly higher than those with autoimmune diseases complicated with non-invasive pulmonary fungi (P <0.05). Using ROC curve analysis, we found that the G test has a high diagnostic value (0.83 for the area under the ROC curve) in patients with autoimmune diseases associated with invasive pulmonary fungal infection. In the 1,3-beta-D-glucuronidase The sensitivity, specificity, positive predictive value and negative predictive value of the diagnostic value of glycans = 93.8 pg / ml were 0.65 (95% confidence interval 0.56-0.73), 0.87 (95% confidence interval 0.83-0.92) and 0.70 95% confidence interval 0.64 ~ 0.81), 0.83 (95% confidence interval 0.79 ~ 0.88). Conclusion The G test is of great value in the diagnosis of autoimmune diseases complicated with invasive pulmonary mycosis.