| الوصف: |
To analyze the diagnostic value of (1, 3) -β-D-glucan and galactomannan (GM) tests in the patients with acute leukemia complicated by invasive fungal disease, and explore the application of serological detection (G/GM) and lung CT for early diagnosis of invasive fungal disease (IFD).A total of 493 patients with acute leukemia complicated by high risk invasive fungal infection, also receival G and GM tests, in Department of hematology of our hospital from June 2016 to December 2016 were selected and were divided into IFD-confirmed group (62 cases) including confirmed and clinical diagnesed IFD, and IFD-unconfirmed group (431 cases) including suspected IFD and non-IFD according to the diagnostic criteria of IFD. The results of G and GM tests in patients of 2 groups were analyzed, then the diagnostic efficacy of G and GM done and combination evaluated. In addition, 26 patients whose lung CT negative at hospitalization, moreover, presentation of changes in lung by CT during hospitalization and serological G and GM test positive were selected, and the difference of time between serological that postive and presentation of changes in lung by CT were compared for the estimation of early diagnotic value.The positive rate of (1, 3) -β-D-glucan in IFD-confirmed group and IFD-unconfirmed group was 56.5% and 10.4%, respectively. Meanwhile, that of galactomannan test was 41.9% and 9.0%, respectively. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of (1, 3) -β-D-glucan was 56%, 90%, 44% and 92%, and that of galactomannan was 42%、91%、40% and 93%, respectively. Moreover, the combination of (1, 3) -β-D-glucan and galactomannan could raise the sensitivity to 69% and specificity to 98%. The positive results of serological detection (G/GM) come earlier about five days than CT changes.Both (1, 3) -β-D-glucan and galactomannan test have high sensitivity and specificity, and the combination of them can improve the diagnostic efficacy, and make the clinical antifungal therapy more precisely. In the early clinical diagnosis of IFD, the positive results of serological detection coming earlier than lung CT.G及GM试验在急性白血病合并侵袭性真菌病中的诊断价值.分析G及GM试验在急性白血病患者合并侵袭性真菌病中的诊断效能，及其与CT在侵袭性真菌病早期诊断中的应用。.本院血液科2016年下半年急性白血病患者怀疑侵袭性真菌病（IFD）行G及GM试验检测的病人共493例。根据IFD的诊断标准，将患者分为：IFD确定组（包括确诊及临床诊断IFD，62例），IFD未确定组（包括拟诊及非IFD，431例）。分析2组患者G及GM试验结果，并评价二者单独及联合诊断的诊断效能。此外，从病例中筛选入院时肺部CT结果阴性，在住院过程中CT显示肺部有改变及血清学检测结果显示阳性的患者26例，比较血清学检测阳性结果与CT显示肺部改变的时间差异。.G试验在IFD确定组和IFD未确定组中的阳性率分别是56.5%和10.4%；GM试验在2组中的阳性率分别是41.9%和9.0%。G试验的灵敏度、特异度、阳性预测值及阴性预测值分别是56%、90%、44%、92%；GM试验分别是42%、91%、40%、93%，并且二者联合诊断的灵敏度和特异度可分别提高到69%和98%。血清学检测（G/GM试验）阳性结果比肺部CT改变早出现大约5 d。.G及GM试验有较高的灵敏度和特异度，且两者联合使用能提高诊断效能，更准确地指导临床抗真菌治疗用药。在早期临床诊断IFD上，血清学检测阳性结果比CT显示肺部改变出现较早。. |
