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目的探讨血清半乳甘露聚糖(GM)试验在侵袭性曲霉菌病(IA)诊断中的应用价值。方法选取658例具有IA高危因素患者血清标本进行GM试验,同时进行痰液、支气管肺泡灌洗液、胸水、腹水标本的直接涂片镜检和真菌培养,分析评价GM试验对IA的诊断价值。结果 GM试验阳性162例,阳性率为24.62%。IA患者主要见于ICU和呼吸内科,分别占39.77%和35.22%;IA病种分布,以呼吸道感染者居多,共122例,占69.32%,其中肺部感染占45.46%,慢性阻塞性肺病占23.86%。真菌培养结果显示,烟曲霉菌占首位,为89.13%。GM试验的灵敏度、阴性预测值高于直接涂片镜检和真菌培养2种方法,而其特异度和阳性预测值则低于直接涂片镜检和真菌培养2种方法。结论 GM试验对诊断IA具有重要的参考价值。
Objective To investigate the value of serum galactomannan (GM) test in the diagnosis of invasive aspergillosis (IA). Methods Serum samples of 658 patients with IA risk were selected for GM test, sputum, bronchoalveolar lavage fluid, pleural effusion and ascites samples were directly smear microscopy and fungal culture to evaluate the diagnostic value of GM test for IA. Results 162 cases of GM test positive, the positive rate was 24.62%. IA patients mainly found in the ICU and respiratory medicine, accounting for 39.77% and 35.22% respectively; IA disease distribution, respiratory tract infections are mostly, a total of 122 cases, accounting for 69.32%, of which 45.46% were pulmonary infections, chronic obstructive pulmonary disease accounted for 23.86 %. Fungal culture results showed that Aspergillus fumigatus accounted for the first place, 89.13%. The sensitivity and negative predictive value of GM test were higher than those of direct smear and fungal culture, while the specificity and positive predictive value of GM test were lower than those of direct smear microscopy and fungal culture. Conclusion GM test has important reference value for the diagnosis of IA.