以G试验阳性误诊为侵袭性真菌感染1例.docVIP

以G试验阳性误诊为侵袭性真菌感染1例 　　[摘要] 目的 提高正确分析血浆（1， 3）-β-D-葡聚糖检测（G试验）阳性的认识。方法 报道1例因G试验阳性而被误诊为侵袭性真菌感染的多发性骨髓瘤患者，并结合文献复习。结果 患者行VDT方案化疗，硫普罗宁保肝，期间出现高热，G试验阳性，予经验性抗真菌治疗，因严重副反应未完成。但停用硫普罗宁后，体温恢复正常，G试验正常。结论 G试验因其阳性预测值及特异性低，在诊断侵袭性真菌感染时存在局限性，应加深对G 试验阳性的认识，避免过度治疗。 　　[关键词] （1， 3）-β-D-葡聚糖；侵袭性真菌感染；误诊 　　[中图分类号] R519 [文献标识码] B [文章编号] 1673-9701（2013）36-0125-02 　　Misdiagnosis of invasive fungal infection due to positive G assay and literature review 　　YIN Li RAO Jin LIN Zhimei 　　Endocrine Onset，Chengdu University Affiliated Hospital，Chengdu 610081，China 　　[Abstract] Objective To recognize the importance of correctly analyzing the positive result of （1， 3）-β-D-glucan assay（G assay）. Methods One case of multiple myeloma was misdiagnosed as being complicated with invasive fungal infection due to positive G assay and literature review was combined. Results The patient with multiple myeloma was treated with VDT regimen and liver-protective Tiopronin，during which he got a high fever and the G assay was positive、Empirical antifungal-infective therapy was then implemented but discontinued because of severe adverse reaction. However in his repeated hospitalization， body temperature and the serum level of （1，3）-β-D-glucan returned to normal each time Tiopronin was discontinued. Conclusion The G assay has limited usefulness because of its low positive predictive value and specificity in the diagnosis of invasive fungal infections. The correct judgment of G assay is essential to make diagnosis and avoid excessive treatment. 　　[Key words] （1， 3）-β-D-glucan； Invasive fungal infection； Misdiagnosis 　　侵袭性真菌感染（invasive fungal infection，IFI）是血液系统恶性肿瘤严重而且致命的并发症。早期诊断以及抗真菌药物的早期应用决定了这类恶性肿瘤患者的预后[1]，但传统的微生物检测方法如培养、病理活检因其时间长、有创性无助于早期诊断和治疗。（1，3）-β-D-葡聚糖广泛存在于除接合菌、隐球菌的真菌细胞壁中，进入人体后释放入血，使血中浓度升高，因此检测血浆中的（1， 3）-β-D-葡聚糖（G试验）可作为IFI早期诊断指标[2] 。但临床研究表明，G试验频现假阳性，阳性预测值低，限制了其在血液系统恶性肿瘤中的临床应用[3]。本文报道因G试验阳性误诊为侵袭性真菌感染的多发性骨髓瘤患者一例，以提高对正确分析G试验阳性的认识。 　　1病例资料 　　患者男，78岁，因左侧腰痛1个月，检查发现免疫球蛋白升高1 d于2012年11月27日入住我院肾内科。既往有慢性阻塞性肺疾病病史。生化检查