【目的】探讨支气管肺泡灌洗液(BALF)中(1,3)-β-D-葡聚糖(BG)水平检测(G试验)对儿童侵袭性肺真菌病(IPFI)的诊断价值。【方法】选择本院收治的135例患儿,其中IPFI组34例、单纯肺炎组53例、非感染组48例,对所有入选患儿进行纤维支气管镜检查,留取BALF,同时采血行血清G试验。【结果】IPFI组BALF中BG水平和血清BG水平分别为(121.0士65.93)ng/L(23.29士20.49)ng/L,均明显高于单纯肺炎组(27.6士10.35)ng/L、(9.8±7.62)ng/L和非感染组(10.0±6.25)ng/L、(5.0±5.12)ng/L,其差异有统计学意义(P〈0.05);IPFI组BALF中BG水平明显高于同组血清BG水平,其差异有统计学意义(P〈0.05);BALF样本G试验用于诊断IPFI的最佳临界值是42.02ng/L,其灵敏度和特异度均明显高于血清G试验检测。【结论】BALF样本G试验诊断IPFI较血清标本具有更高的灵敏度和特异度,且在区分单纯肺炎和真菌感染方面可能比血清G试验更有优势,可减少IPFI的误诊、漏诊,为抗真菌药物的使用提供依据。
[Objective]To explore the value of (1,3)-β-D-gluean(G test), in bronehoalveolar lavage fluid (BALF) for the diagnosis of invasive pulmonary fungal infection(IPFI) in children. [Methods] A total of 135 pediatric patients hospitalized in our hospital were chosen and divided into IPFI group( n = 34), simple pneumonia group( n = 53) and non-infection group (n = 48). All patients underwent fiberoptic bronchoscopy. BALF was collected. Meanwhile blood samples were collected for serum G test. [Results] The G test levels in BALF and serum of IPFI group were 121±65.93 ng/L and 23.49±20.49 ng/L respectively, which were oh viously higher than those in simple pneumonia group(27.6 ±10.35 ng/L and 9.8 ± 7.62 ng/L, respectively) and non-infection group(10±-6.25 ng/L and 5±5. 12 ng/L, respectively), and there were significant differences( P 〈0.05). The G test levels in BALF of IPFI group were obviously higher than those in serum of same group, and there was significant difference( P 〈0.05). The best critical value of G test in BALF for the diagnosis of IPFI was 42.02 ng/L. The sensitivity and specificity of G test in BALF for the diagnosis of iPFI were obviously higher than those of serum G test. [Conclusion] The G test in BALF for the diagnosis of IPFI has higher sensitivity and specificity than that in serum. The G test in BALF for distinguishing simple pneumonia and fungal infection has more advantages than serum G test, and it can reduce misdiagnosis and missed diagnosis, and provide the basis for the use of antifungal drugs, and decrease the mortality rate of IPFI in children.