| Objective:In recent years, with the aging of the population, hematopoietic stem cell and organ transplantation with immunosuppressive drugs, cancer chemotherapy, the application of ultra-broad-spectrum antibiotics and a variety of catheter interventional treatment etc, IFI is rising year by year, among which IPFI the most common, the morbidity and mortality rates remain high, a serious threat to the lives of patients. Usually the early diagnosis of IFI is difficult, on one hand is without specific clinical manifestations of early, on the other hand is due to the current culture is difficult to meet the requirements. Fungal antigen test undertaken in recent years, especially in plasma G test and GM test as a non-invasive diagnostic method, with the early rapid, high sensitivity and specificity advantages.GM test mainly detected aspergillus, while G test can be more broad-spectrum detection of fungal infection. Also G test of plasma is influenced by many factors, which be more prone to false positive and false negative, and early BG has not released into the blood, so it will affect early diagnosis and treatment.In some body fluids such as BALF, urine, cerebrospinal fluid etc, fungal antigens can be detected. In order to find early diagnostic method of IPFI, provide the basis for the treatment, we did G test of BALF, and compared with G test of plasma, and explored the value of G test of BALF.At present,there is no clinical study reports about G test of BALF at home and abroad.Method:1. We selected 137 patients in the General Hospital of Tianjin Medical University from February in 2010 to February in 2011, including 36 IPFI patients,36 cases who be confirmed or clinically diagnosed, as the study group, including 53 simple pneumonia patients who are with pneumonia alone,and 48 patients of non-infected group who are with cough of unknown origin without any signs of infection and no risk factors for IFI, both as the control groups.2. All patients underwent BAL.We obtained the BALF from the disease leaf in IPFI group and pneumonia group, from the right middle lobe or lingular lobe of left lung in non-infected group.3. Recorded the total of BALF,and divided BALF into 3 parts, one part was taked bacteria examination, another part was quickly transferred to pyrogen-free test tube for G test, and the other part was for cell count.4. All the patients taked G test of plasma.5. Statistical analysis:analysed whether there is significant difference between the three groups of G tests of BALF and plasma (P<0.05). Drew ROC curve, and determined the best threshold of two methods, and compared the value of both. And analysed the relationship between G test of BALF and cell count, blood, blood gas analysis, CRP in IPFI group.Results:1.G test of BALF:the median of IPFI group, simple pneumonia group and non-infection group were 281.0,27.6,10.0ng/L, IPFI group was significantly higher than pneumonia group(U=134.0,P<0.001) and non-infection group (U=147.0,P<0.001);it is no significant difference between pneumonia group and non-infection group (U=904.0,P>0.05).2. ROC area under the curve of G test of BALF for the diagnosis of IPFI is 0.923 (P<0.001), the best threshold is 67.17ng/L.3.G tests of plasma:the median of IPFI group, simple pneumonia group and non-infection group (interquartile range) were 27.49,9.8,5.0 ng/L, IPFI group was significantly higher than pneumonia group (U=491.0, P<0.001) and non-infection group (U=277.0, P<0.001); it is no significant difference between pneumonia group and non-infection group (U=1045.5, P>0.05).4. ROC area under the curve of G test of plasma for the diagnosis of IPFI is 0.789 (P<0.001), the best threshold is 17.28ng/L.5. ROC curve and area under the curve prompt that the sensitivity and specificity of G test of BALF for the diagnosis IPFI were higher than G test of plasma. 6. There is no significant correlation between G test of BALF in IPFI group and WBC and neutrophil percentage.7. In IPFI group, G test of BALF was positively correlated with CRP (r=0.432, P=0.009).8. In IPFI group, G test of BALF was negatively correlated with PaO2 (r=-0.363, P=0.030), there is no significant correlation between G test of BALF and PCO2 and PH value (P>0.05).Conclusion:1. BG in BALF was significantly higher than plasma, and G test of BALF may be more advantageous than that of plasma in distinguishing simple pneumonia and fungal infection.2. The sensitivity and specificity of G test of BALF were higher than those of G test of plasma, suggesting that G test of BALF has earlier, more accurate, higher clinical value than G test of plasma in the diagnosis of IPFI.3. The best diagnostic threshold of G test of BALF is 67.17ng/L, suggesting that when the value≥67.17ng/L, it may be IPFI; when the value≥404.15ng/L. the diagnosis of IPFI will be basically established.4. G test of BALF was positively correlated with CRP in IPFI patients, so G test of BALF may prompt the severity and prognosis of disease.5.G test of BALF was negatively correlated with PaO2. In IPFI patients, with the higher level of G test, the hypoxemia was more serious. |
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