陈伟玲 李乐 邓虹 黄颖妍

[摘要] 目的 分析侵袭性真菌病（IFD）诊断中BALF GM试验的准确率、特异度、灵敏度。 方法 选定本院2018年1月至2021年1月收治的40例疑似IFD患者作为观察组，以及同期收入院的40例肺部细菌性感染者组作为对照组，比较两组BALF以及血清GM试验结果。计算GM试验的诊断准确率、灵敏度、特异度。 结果 观察组BALF及血清GM试验结果均高于对照组，差异均有统计学意义（P<0.05）;观察组以及对照组BALF GM试验结果均高于血清 GM试验结果，差异均有统计学意义（P<0.05）;BALF GM试验诊断准确率85.00%、灵敏度91.89%、特异度66.67%均高于血清GM试验的75.00%、81.08%、33.33%，差异均有统计学意义（P<0.05）。 结论 BALF GM试验在IFD诊断中具有较高的准确率、灵敏度、特异度，对IFD患者病情判断及临床治疗具有重要的指导意义。

[关键词] 侵袭性真菌病;半乳甘露聚糖检测;肺泡灌洗液;诊断效能

[中图分类号] R519          [文献标识码] B          [文章编号] 1673-9701（2021）33-0120-04

[Abstract] Objective To analyze the accuracy， specificity and sensitivity of bronchoalveolar lavage fluid galactomannan （BALF GM） test in the diagnosis of invasive fungal disease（IFD）. Methods A total of 40 patients with suspected IFD admitted to our hospital from January 2018 to January 2021 were selected as the observation group， and 40 patients with pulmonary bacterial infection admitted to our hospital in the same period were selected as the control group. The BALF and serum GM test results of the two groups were compared. The diagnostic accuracy， sensitivity and specificity of GM test were measured. Results The test results of BALF and serum GM in the observation group were higher than those in the reference group， with statistically significant differences（P<0.05）. The results of BALF GM test in the observation group and control group were higher than those of serum GM test， with statistically significant differences （P<0.05）. The diagnostic accuracy （85.00%）， sensitivity （91.89%） and specificity （66.67%） of BALF GM test were higher than those of serum GM test（75.00%， 81.08%， 33.33%）， and the differences were statistically significant（P<0.05）. Conclusion BALF GM test has high accuracy， sensitivity and specificity in the diagnosis of IFD， and it has important guiding significance for the diagnosis and clinical treatment of patients with IFD.

[Key words] Invasive fungal disease; Detection of galactomannan; Alveolar lavage fluid; Diagnostic efficiency

侵襲性真菌病（Invasive fungal disease， IFD）是由于真菌侵入血液或组织而引发组织损伤、炎性反应的感染性疾病[1]。近年来，随着抗肿瘤药物、抗生素、免疫抑制剂的广泛应用，IFD的发生率明显增高[2]。据流行病学调查显示，我国IFD的发生率高达41.18%，死亡率高达60%[3]。IFD具有疾病进展速度快、病情凶险、死亡率高等特点[4]。故及早对IFD患者病情作出诊断，对改善患者预后具有重要意义。半乳甘露聚糖检测（GM试验）是近年来兴起的一项诊断技术，优点是无创伤性、灵敏度高、特异度高[5]。基于此，为进一步探究IFD诊断中GM试验的临床价值，本研究选定本院2018年1月至2021年1月收治的40例疑似IFD患者以及同期收入院的40例肺部细菌性感染者研究，现报道如下。

1 资料与方法

1.1 一般资料

选定本院2018年1月至2021年1月收治的40例疑似IFD患者作为观察组，以及同期收入院的40例肺部细菌性感染者组作为对照组，已征得患者家属知情并签署知情同意书。观察组男21例、女19例;年龄42～85岁，平均（63.24±10.17）岁;病程在2～11 d，平均（6.52±2.34）d;原发疾病：6例风湿性心脏病、8例间质性肺疾病、5例糖尿病、21例慢性阻塞性肺疾病（COPD）;体重46～87 kg，平均（61.52±5.07）kg。……