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中国循证儿科杂志

中国循证儿科杂志 ›› 2020, Vol. 15 ›› Issue (4): 280-284.

• 论著 • 上一篇    下一篇

(1,3)-β-D-葡聚糖和半乳甘露聚糖抗原检测侵袭性真菌 感染高危儿童的诊断准确性研究

张明强1, 赵瑞秋1， 余国容2， 许红梅1   

  1. 重庆医科大学附属儿童医院，儿童发育疾病研究教育部重点实验室，国家儿童健康与疾病临床医学研究中心，儿童发育重大疾病国家国际科技合作基地，儿科学重庆市重点实验室重庆，400014  1 感染科，2 放射科
  • 收稿日期:2019-12-09 修回日期:2020-01-12 出版日期:2020-08-25 发布日期:2020-08-25
  • 通讯作者: 余国容; 许红梅

Evaluation of clinical features of invasive fungal disease in high-risk children and the diagnostic value of G/GM test

ZHANG Ming-qiang1, ZHAO Rui-qiu1, YU Guo-rong2, XU Hong-mei1   

  1. 1 Department of Infectious Diseases, 2 Department of Radiology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorder, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University
  • Received:2019-12-09 Revised:2020-01-12 Online:2020-08-25 Published:2020-08-25
  • Contact: YU Guo-rong; XU Hong-mei

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摘要： 目的：分析高危儿童侵袭性真菌病（IFD）的临床及影像学特征，探讨(1,3)-β-D-葡聚糖检测（G试验）和半乳甘露聚糖（GM）抗原检测（GM试验）在儿童IFD中的诊断价值。方法：纳入2015年6月至2019年6月在重庆医科大学附属儿童医院怀疑真菌感染并行血清G试验+GM试验+真菌培养的住院患儿，按照IFD诊断标准分为IFD组和非IFD组。分析IFD组患儿的临床及影像学特征，计算G试验、GM试验诊断IFD的诊断参数。结果：IFD组64例，确诊24例，临床诊断40例；非IFD组100例。IFD组肺部影像学表现以斑片影、结节影、胸腔积液常见，而空洞、晕征相对较少。曲霉菌感染患儿晕征、空气新月征发生率较非曲霉菌感染患儿高，非曲霉菌感染患儿的IFD患儿肺部CT表现以斑片影、结节影为主，空洞、晕征极少。64例IFD患儿中培养出64株病原体，以白色假丝酵母菌检出率最高（42.2%），曲霉菌10例（15.6%）；G试验敏感度为68.8%、特异度为87.0%，GM试验敏感度为80.0%、特异度为95.0%。G试验和GM试验ROC曲线下面积分别为0.79（95%CI：0.72~0.87）和0.92（95%CI：0.82~1.00）。结论：儿童IFD临床及影像学表现不典型，肺部影像学以斑片影、结节影、胸腔积液常见；G试验对儿童IFD有中等诊断价值；而GM试验对儿童曲霉菌IFD有较高诊断价值。

关键词: (1,3)-β-D-葡聚糖, 半乳甘露聚糖, 儿童, 临床特征, 侵袭性真菌病

Abstract: Objective:To analyze the clinical and imaging characteristics of invasive fungal disease (IFD) in high-risk children, and to evaluate the clinical value of serum (1,3)-β-D-glucan and galactomannan detection in children with IFD. Methods: Retrospective analysis was performed on children admitted to Children’s Hospital of Chongqing Medical University from June 2015 to June 2019, who were suspected of fungal infection and completed G test, GM test and fungal culture. According to invasive fungal disease diagnostic criteria, the study subjects were divided into IFD group and non-IFD group. The clinical characteristics of children with IFD were analyzed, and the sensitivity and specificity of the G test and the GM test for the diagnosis of IFD were calculated. Results: There were 64 patients in the IFD group with 24 of proven IFD and 40 of probable IFD. There were 100 cases in non-IFD group. Pulmonary patchy, nodules, and pleural effusions were common in the lung imaging findings in the IFD group, but there were relatively fewer cavitation and halo sign. Children with Aspergillus infection had higher incidence of halo sign and air crescent sign than those with Candida infection. In children with non-Aspergillus infection, the CT appearance of the lung was mainly patchy and nodular, with few signs of cavitation and halo sign. Sixty-four pathogenic fungi were detected in 64 children with IFD, among which Candida albicans had the highest detection rate of 42.2%, and Aspergillus was detected in 10 children (15.6%). The sensitivity and specificity of G test was 68.8% and 87.0% respectively and the sensitivity and specificity of GM test was 80.0% and 95.0% respectively. The area under the ROC curve for G test and GM test was 0.79 (95% CI：0.72~0.87) and 0.92 (95% CI：0.82~1.00), respectively. Conclusion: The clinical and imaging manifestations of IFD in children are not typical, and the typical cavitation and halo signs in lung imaging are relatively few. Patches, nodules, and pleural effusions are common. The (1,3)-β-D-glucan has a moderate value for the diagnosis of non-Aspergillus IFD in children, while the GM test has a high diagnostic value for Aspergillus IFD in children.

Key words: -D-glucan, Galactomannan, Invasive fungal disease, Children, Clinical features, (1,3)-&beta