Study On The Plasma (1,3)-beta-D-glucan Detection In The Clinical Application Of Invasive Fungal Disease In Elderly People

Objective To investigate the clinical diagnosis and treatment of invasive fungal diseases (IFD) with plasma (1,3)-beta-D glucan detection (G test) in elderly patients.Methods Select the older hospitalized patients between November 2012 and September 2014 in Anhui Provincial Hospital suspected with invasive fungal infection, whose age older than 60 years or more.All patients was collectioned venous blood two times to detect plasma (1,3)-beta-D glucan (BG) concentration in consecutive 2 days, plasma G test results and time was recorded.According to the diagnostic standard of IFD,the selected cases etrospectively grouped of diagnosis of IFD, IFD, clinical diagnosis of IFD,suspected IFD and non IFD. Calculation of G test sensitivity, specificity, positive predictive value (PV+), and negative predictive value (PV-), the accuracy of diagnosis in the early diagnosis of IFD in elderly people. Continuously monitoring the plasma (1,3)-beta-D glucan concentrations after antifungal therapy of 7d,14d,28d on the patients whose plasma G test positive, observe the relationship between the plasma (1,3)-beta-D glucan changes with patients, antifungal therapy and prognosis.Results 1.112 aged hospitalized patients clinically suspected with IFD was investigated,among them,78 male cases,34 female cases,the minimum age of 60 years, the maximum age of 98 years old, the average age of (76.2 + 4.3) years old, Among them,10 confirmed IFDs cases,36 the clinical diagnosis IFD cases,42suspected IFD cases,24 non IFD cases.2.10 cases of IFD, the positive rate of plasma G test is 70%(7/10),36 cases of Clinical diagnosis IFD, the positive rate of plasma G test is 75%(27/36), 42 cases of suspected IFD, the positive rate of plasmaG test is 66.7%(28/42),24 cases of non IFD, the positive rate of plasma G test is 41.6%(10/24). Positive time of plasma G test appeared earlier than the fungal culture 3-9d, average 6.17+ 3.42d.Take the plasma G test positive of the diagnosis and clinical diagnosis of IFD cases as the true positive of G test, take the plasma G test negative of non IFD as the true negative of G test.34 Plasma G test cases was true positive,14 Plasma G test cases was true negative,10 false positive cases,12 false negative case.the sensitivity of plasma G test was 73.9%, specificity of 58.3%, positive predictivevalue of 73.9%, the negative predictive value was 58.3%, the diagnostic accuracy of 68.6%.3. A total of 72 patients,the plasma G test was positive before antifungal treatment, among them,48 patients was completed continuous monitoring the plasma (1,3)- beta -D concentration Of anti fungal treatment 7、14、28 days.Asses the disease after 28d treatment,32cases of effective,16 cases of ineffective, Compared with before the antifungal treatment, after antifungal treatment 14、28 days, plasma 1.3--beta glucan levels in the patients of effective treatment declified gradually (P<0.01), While in the patients of no effect had no significant decrease (P>0.05), After anti fungal treatment 7、14、28 days, the plasma 1.3--D beta glucan levels of the patients had statistical differences between two groups(P<0.01).Conclusion Plasma 1,3-0-D glucan detection has the clinical values of early diagnosis and monitoring the therapeutic effect of invasive fungal infection in elderly people.