【作者】 黄琳；

【导师】 夏吉荣；

【作者基本信息】 重庆医科大学 ， 临床医学（专业学位）， 2019， 硕士

【摘要】 目的:通过血液真菌培养结果来探讨G试验和GM试验诊断IFD的诊断价值。方法:对重庆医科大学附属第一医院2017年3月-2018年6月间同时做了G试验、GM试验和血真菌培养的住院患者的检查结果进行回顾性分析,收集到临床疑似IFD病例共455例。将血培养真菌阳性作为IFD确诊指标,同时将病例分为IFD组和非IFD组;其中,IFD组49例,非IFD组406例。统计学分析G试验和GM试验诊断侵袭性真菌感染的Sen、Spe、PPV、NPV、符合率等效能指标。结果:IFD组G试验和GM试验检测值分别为:243.7±268.3pg/mL和0.47±0.70血清学指数;非IFD组G试验和GM试验检测值23.1±52.3pg/mL和0.25±0.24血清学指数。两者间数值差异有统计学意义(P<0.001)。G试验和GM试验对IFD诊断的Sen、Spe、PPV、NPV、符合率、约登指数分别为65.3%、95.3%、62.7%、95.7%、92.1%、0.606和24.5%、93.6%、31.6%、91.1%、86.2%、0.181;其中联合试验诊断IFD的特异度为99.0%。结论:以血培养真菌结果作为IFD诊断的“金标准”来研究G试验与GM试验的临床应用价值,减少了因临床诊断IFD带来的不确定性。本研究表明G试验对诊断IFD体现出较好的诊断价值,且联合GM检测可提高诊断IFD的灵敏度和准确性;另外阴性检测结果对排除诊断IFD也不容忽视,对两项试验合理应用、综合分析可提高IFD的诊疗水平,促进早期诊断,进一步降低误诊率及漏诊率。更多还原

【Abstract】 Objective: To investigate value of G test and GM test for IFD was discussed through the results of blood fungal culture.Methods:A retrospective analysis was performed on the results of inpatients with G test,GM test,and fungal blood culture conducted at the First Affiliated Hospital of Chongqing Medical University from March2017 to June 2018.A total of 455 suspected suspected IFDs were collected.Using postive blood culture fungal as gold standard to confirm IFD,the cases were divided into IFD group and non-IFD group,IFD group: 49 cases;non-IFD group:406 cases;The G and GM tests were used to diagnose the invasive fungal infections of Sen,Spe,PPV,NPV,and the equivalent energy index.Results:The IFD group’s G test values were: 243.7±268.3 pg/mL and GM test serological index were 0.47±0.70;non-IFD group G tests and GM test serological index were respectively 23.1±52.3pg/mL and 0.25±0.24,the difference between the two groups was statistically significant(P<0.001).The sensitivity,specificity,positive predictive value,negativepredictive value,coincidence rate,and Youden index of the G test and GM test for IFD diagnosis were 65.3%,95.3%,62.7%,95.7%,92.1%,0.606,and 24.5%,respectively 93.6%,31.6%,91.1%,86.2%,0.181;The specificity of the combined diagnosis of IFD was 99.0%.Conclusion: The clinical application value of G test and GM test was studied by using the results of blood culture fungi as the "gold standard" for the diagnosis of IFD,which reduced the uncertainty caused by the clinical diagnosis of IFD.This study showed that G test showed better diagnostic value for the diagnosis of IFD,and combined with GM test could improve the sensitivity and accuracy of the diagnosis of IFD.In addition,negative test results can not be ignored in excluding diagnosis IFD.Reasonable application and comprehensive analysis of the two tests can improve the diagnosis and treatment level of IFD,promote early diagnosis,and further reduce the rate of misdiagnosis and missed diagnosis.更多还原