【摘要】目的分析1-3-β-D-葡聚糖(1-3-β-D glucan,BG)和半乳甘露聚糖(galactomannan,GM)检测在早期诊断腹膜透析相关真菌性腹膜炎中的临床应用价值。方法回顾性分析陆军特色医学中心肾内科2008 年1 月～2019 年1 月持续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis, CAPD)明确诊断腹膜炎的患者，纳入完善了血清BG 和GM 检测的患者63 例，腹水培养有真菌的患者22 例，培养为细菌的患者41 例，对照组11 例。共纳入分析74 例，其中男性38 例，女性36 例，平均年龄(50.65±13.31)岁，平均透析龄(37.08±25.01)月。血清BG 和/或GM 检测大于临界值，立即联合使用氟康唑或伏立康唑抗感染治疗，收集入院至起始抗真菌治疗时间、住院时间、90 天生存情况。采用4 格表评价BG 检测、GM 检测及二者联合检测对真菌性腹膜炎的诊断效能。结果BG 和GM 检测对真菌性腹膜炎的诊断灵敏度、特异度、阳性预测值和阴性预测值分别为：86.4%，95.1%，90.5%，92.9%和36.4%,92.7%，72.7%，73.1%。联合检测诊断灵敏度达到95.5%，特异度达97.6%。联合检测组入院至起始抗真菌治疗时间短于对照组(t=12.751, P<0.001), 联合检测组平均住院时间短于对照组(t=3.649,P=0.001)。联合检测组90天生存率显著高于对照组(c2=5.515, P= 0.019)。结论BG、GM 联合检测可以早期诊断真菌性腹膜炎，且有较高的灵敏度和特异度，为疾病的治疗提供有力的依据，改善患者预后及降低病死率。
【Abstract】Aim To evaluate the clinical application value of 1- 3- β-D glucan (BG) and galactomannan (GM) detection in the early diagnosis of peritoneal dialysis-related fungal peritonitis. Method The continuous ambulatory peritoneal dialysis (CAPD) patients diagnosed with peritonitis during January 2008 to January 2019 were retrospectively analyzed. In these patients, detections of serum BG and GM were performed in 63 cases. Fungi were detected in ascites in 22 cases; bacteria were found in ascites in 41 cases; we also enrolled 11 cases as the controls. In the 74 cases we analyzed in this study, 38 cases were males and 36 cases were females, with the average age of 50.65±13.31 years and the average dialysis age of 37.08±25.01 months. When the results of serum BG and/or GM tests greater than the borderline values, combined therapy containing fluconazole or voriconazole was issued immediately. The period between admission and initiation of antifungal therapy, hospitalized day, and survival rate within 90 days were recorded. The diagnostic value for fungal peritonitis using BG test, GM test and combined BG and GM tests was assessed by a 4-cell scale method. Results The diagnostic sensitivity, specificity, positive predictive value and negative predictive value for fungal peritonitis were 86.4%, 95.1%, 90.5% and 92.9% respectively by BG test, and were 36.4%, 92.7%, 72.7% and
73.1% respectively by GM test. The diagnostic sensitivity and specificity for fungal peritonitis were 95.5% and 97.6% respectively by combined BG and GM tests. The period between admission and initiation of antifungal therapy was shorter in patients undergoing combined BG and GM tests than in the control cases (15.71± 5.65h vs. 50.18±9.99h, P=0.000); the average hospitalized day was also shorter in patients undergoing combined BG and GM tests than in the control cases (15.64±3.55 days vs. 21.00±4.75 days, P=0.001); the survival rate within 90 days was higher in patients undergoing combined BG and GM tests than in the control cases (95.45% vs. 63.64%; c2=5.515, P=0.019). Conclusion Simultaneous BG and GM tests provide a powerful tool for the early diagnosis of fungal peritonitis with higher sensitivity and specificity, from which antifungal medications can be given earlier, and better prognosis and lower mortality rate can be obtained in patients with PD-related fungal peritonitis.
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