多指标单独或联合检测在艾滋病合并马尔尼菲篮状菌感染的诊断价值OACSTPCD
The diagnostic value of multiple indicators alone or unite test in AIDS patients complicated with Talaromy-ces marnef fei infection
目的 探讨多个指标单独或联合检测在艾滋病合并马尔尼菲篮状菌感染诊断中的应用价值.方法 回顾性分析我院2018年10月-2021年12月期间住院的艾滋病患者临床资料,经纳排标准筛选得到789例患者资料.依据马尔尼菲篮状菌分离培养和鉴定以及临床诊断等结果,将157例确诊为艾滋病合并马尔尼菲篮状菌感染定义为TM组;632例无马尔尼菲篮状菌感染的艾滋病患者定义为非TM组.采用Mann-Whitney U检验,比较两组之间降钙素原(Procalcitonin);腺苷脱氨酶(Adenosine deaminase);乳酸脱氢酶(lactate dehydrogenase);半乳甘露聚糖(Galactomannan);(1,3)-β-D-葡聚糖[(1,3)-beta-D-glucan]和 CD3+、CD8+、CD4+T 淋巴细胞计数的差异;利用 ROC 曲线分析 PCT、ADA、LDH、GM 和 G 在CD4+T淋巴细胞计数≤50个/μL的AIDS合并TM感染患者诊断中的应用价值;分析GM、ADA和G试验联合检测在CD4+T淋巴细胞计数≤50个/μL的AIDS合并TM感染患者中的应用价值.结果 与非TM组相比较,TM组的PCT、ADA、LDH、GM和G水平明显增高,差异有统计学意义(P＜0.0001),TM组的CD3+、CD8+、CD4+T淋巴细胞计数明显低于非TM组,差异有统计学意义(P＜0.0001);经ROC曲线分析综合得出GM、ADA和G三个指标在CD4+T淋巴细胞计数≤50个/μL的AIDS合并TM感染患者中的诊断价值较高;在所有联合检测的方案中ADA、GM和G串联的特异性(99.53％)和阳性预测值(98.15％)最高;ADA和G串联的诊断准确率最高(77.26％);ADA、GM和G并联的灵敏度(96.03％)和阴性预测值(94.17％)最高.结论 AIDS合并TM感染主要发生在CD4+T淋巴细胞计数≤50个/μL的患者;GM、ADA和G检测在CD4+T淋巴细胞计数≤50个/µL的AIDS合并TM感染患者中的诊断价值较高;在所有联合检测的方案中GM、ADA和G三者联合检测诊断效能最好,可有效提高疾病检出率.
Objective To explore the diagnostic value of multiple indicators alone or unite test in AIDS patients complicated with Talaromyces marneffei infection.Method Retrospective analysis of the clinical data of AIDS patients hospitalized in our hospital from October 2018 to December 2021,The data of 789 patients were obtained by the standard screening.Ac-cording to the results of Talaromyces marneffei isolation,culture,identification and clinical diagnosis,157 cases of con-firmed AIDS complicated with Talaromyces marneffei infection were defined as the TM group;632 AIDS patients without Talaromyces marneffei infection were defined as the non-TM group.Mann-Whitney U test was used to compare the differ-ences in PCT,ADA,LDH,GM,G and T lymphocyte counts of CD3+,CD8+and CD4+between the two groups.ROC curve was used to analyze the diagnostic value of PCT,ADA,LDH,GM and G in AIDS patients complicated with TM infec-tion whose CD4+T lymphocyte counts ≤50 cells/μL.Analyzing the value of combined GM,ADA,and G tests in AIDS pa-tients complicated with TM infection whose CD4+T lymphocyte counts ≤50 cells/μL.Results The levels of PCT,ADA,LDH,GM and G in the TM group were significantly higher than those in the non-TM group,and the difference was statisti-cally significant(P＜0.0001),The CD34,CD84,and CD44 T lymphocyte counts in the TM group were significantly lower than those in the non-TM group,and the difference was statistically significant(P＜0.0001).After ROC curve analysis,it was concluded that GM,ADA and G were of high diagnostic value in AIDS patients complicated with TM infection whose CD4+T lymphocyte counts ≤50 cells/μL.ADA,GM,and G in tandem had the highest specificity(99.53％)and positive predictive value(98.15％)among all protocols for unite testing.ADA and G tandem had the highest diagnostic accuracy(77.26％).The sensitivity(96.03％)and negative predictive value(94.17％)of ADA,GM and G in parallel were the high-est.Conclusion AIDS complicated with TM infection mainly occurred in patients whose CD4+T lymphocyte counts ≤50 cells/μL.High diagnostic value of GM,ADA,and G tests in AIDS patients complicated with TM infection whose CD4+T lymphocyte counts ≤50 cells/μL.The combination of GM,ADA and G has the best diagnostic efficacy among all protocols for unite testing,which can effectively improve the rate of disease detection.
周游;何希;黄丽花;潘艳娜;黄丽玲;廖家吉;蓝吉慧;覃善芳
广西壮族自治区胸科医院,柳州 545005广西壮族自治区胸科医院,柳州 545005广西壮族自治区胸科医院,柳州 545005广西壮族自治区胸科医院,柳州 545005广西壮族自治区胸科医院,柳州 545005广西壮族自治区胸科医院,柳州 545005广西壮族自治区胸科医院,柳州 545005广西壮族自治区胸科医院,柳州 545005
临床医学
艾滋病马尔尼菲篮状菌CD4+T淋巴细胞计数ROC曲线分析联合检测
AIDSTalaromyces marnef feiCD4+T lymphocyte countROC curve analysisunite test
《中国真菌学杂志》 2024 (5)
480-486,7
广西重点研发计划(桂科 AB23026050)广西医疗卫生适宜技术开发与推广应用项目(S2022042)
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