血浆β-葡聚糖检测儿童侵袭性真菌感染早期诊断价值探讨

Value of plasma β-Glucan in early diagnosis of invasive fungal infection in children

摘要:

目的:随着免疫受损个体生存期的延长，侵袭性真菌感染（invasive fungal infection, IFI）发病率持续上升。本研究目的在于了解儿童真菌感染高危人群并发IFI的发病情况，评价血液1,3-β-D葡聚糖(1,3-β-D-glucan, BG)（G试验）诊断价值。方法:选择2007年11月至2008年6月在我院儿童ICU、血液肿瘤科住院治疗的持续发热4~7 d以上高危感染患儿进行G试验；每周检测1～2次，直至症状好转，或排除真菌感染，或死亡。G试验采用GKT-5M Set动态真菌检测试剂盒检测，阳性定义为血浆BG水平≥10 pg/mL。结果:① 共计130例入选研究。确诊IFI（proven）2例，均为念珠菌血症。临床诊断（probable）20例，拟诊（possible）7例，排除101例；② IFI组住院天数较非IFI组延长（P＜0.05），不良预后率明显增加（P＜0.05）；③ IFI组血浆BG水平高于非IFI组(P＜0.01）。G试验诊断敏感度81.8%，特异度82.4%，阳性预测值48.6%，阴性预测值95.7%；④72.2% 病例G试验阳性结果较培养或影像学阳性结果提前或同时发生。结论:儿童高危患者IFI不少见。血液G试验无衡量标准有助于高危患者的筛查，具有早期辅助诊断、指导合理治疗干预的价值。［中国当代儿科杂志，2009，11（11）：905-908］

Abstract:

OBJECTIVE: The incidence of invasive fungal infection (IFI) has risen dramatically along with the prolongation of immunocompromised individuals′ lifespan. This study aimed to investigate the incidence of IFI among highrisk pediatric patients and to evaluate the diagnostic value of circulating (1，3)-β-D-glucan (BG) in IFI. METHODS: High-risk pediatric inpatients from hemato-oncology department and ICU were enrolled from November 2007 to June 2008. All the patients had persistent fever for 4 to 7 days or longer. Circulating BG levels were detected once or twice weekly until the signs and symptoms improved, or IFI was excluded, or death. Circulating BG levels were determined by the GKT-5M Set Kinetic Fungus Detection Kit. Detection of plasma BG was judged positive when the level was ≥10 pg/mL. RESULTS: A total of 130 patients were enrolled. Two patients with candidemia were classified as proven IFI, 20 as probale IFI, 7 as possible IFI, and 101 without IFI. The patients with proven or probable IFI had a longer length of hospital stay (P＜0.05) and an increased mortality rate (P＜0.05）. The patients with IFI demonstrated a higher plasma level of BG than those without IFI (P＜0.01）. The sensitivity, specificity, positive and negative predictive values for plasma BG detction were 81.8%, 82.4%, 48.6% and 95.7% respectively. Positive BG results occurred before the abnormal results on computed tomography scan or fungal culture or simultaneously in 72.2% of the cases. CONCLUSIONS: IFI is not rare among pediatric high-risk patients. Circulating BG detection is accurate to a certain extent in the diagnosis of IFI. It is a useful adjunct means for IFI screening in high-risk patients.［Chin J Contemp Pediatr, 2009, 11 (11):905-908］