研究G试验和真菌培养法对人类免疫缺陷病毒感染者/获得性免疫缺陷综合征（HIV/AIDS）患者合并侵袭性真菌感染的诊断价值。

收集本院2015年6月至2016年5月入院于临床出现真菌感染症状的HIV/AIDS患者共1 423例，取其静脉血行（1，3）-β-D-葡聚糖检测的同时，留取血液或骨髓、痰、灌洗液、咽拭子、脑脊液以及粪便等标本行真菌培养；通过回顾性研究，了解使用抗真菌药后患者临床症状是否缓解作为临床诊断标准，并以此为标准比较两种检测方法的差异。

1 423例患者中使用抗真菌药物后症状缓解588例为侵袭性真菌感染（IFI）组使用抗真菌药物后症状未缓解者835例为非IFI组。以100.5 pg/ml为临界值阳性，G试验阳性患者527例，阴性患者896例，准确度达91.36%；而以90.5 pg/ml、110.5 pg/ml或120.5 pg/ml为临界值阳性时准确度分别为89.88%、90.51%和89.18%；真菌培养阳性患者636例，阴性患者787例。IFI组及非IFI组患者G试验含量分别为（532.83 ± 778.67）pg/ml和（44.14 ± 35.08）pg/ml，两组差异具有统计学意义（t = 15.208、P < 0.001）；IFI组患者中念珠菌感染者、马尔尼菲青霉菌感染者、隐球菌感染者、念珠菌及马尔尼菲青霉菌混合感染者G试验含量分别为（444.29 ± 705.44）pg/ml、（452.78 ± 511.40）pg/ml、（89.56 ± 71.58）pg/ml和（596.28 ± 840.23）pg/ml，隐球菌感染者G试验含量分别与念珠菌感染者（t = 6.581、P < 0.001）、马尔尼菲青霉菌感染者（t = 6.889、P < 0.001）和念珠菌及马尔尼菲青霉菌混合感染者（t = 4.865、P < 0.001）比较，差异均具有统计学意义。G试验及真菌培养法的敏感度分别为84.35%和70.75%，差异具有统计学意义（χ² = 5.331、P = 0.021）；特异度分别为96.29%和73.65%，差异具有统计学意义（χ² = 20.067、P < 0.001）；两方法联合检测后敏感度为96.43%，特异度为70.54%。

HIV/AIDS患者合并IFI诊断方面G试验较真菌培养法简便、快速、阳性率高、特异性也较高，连续监测G试验更有助于提高IFI诊断效率；两者联合检测可提高肺孢子菌及隐球菌的诊断效率，早期预测及确诊马尔尼菲青霉菌感染

To study the diagnostic value of G test and fungal culture method for HIV infection patients/AIDS patients (HIV/AIDS) with invasive fungal infection.

In our hospital from June 2015 to May 2016, total of 1 423 patients with HIV/AIDS who were admitted to the hospital. In pumping blood to do(1, 3)-β-D-glucan detection at the same time, take blood or bone marrow, sputum, lavage fluid, throat swab, cerebrospinal fluid, feces and other specimens for fungal culture. Through retrospective survey, the clinical symptoms of patients after the use of anti-fungal drugs to ease as a clinical diagnostic criteria, and as a standard to compare the differences between the two detection methods.

Among the 1 423 patients, 588 patients were treated with anti-fungal drugs, and patients were treated as invasive fungal infection (IFI) group, while 835 cases of symptom remission after anti-fungal therapy were collected as non-IFI group. When the critical value of 100.5 pg/ml was positive, G test was positive in 527 cases, negative in 896 cases, the accuracy was 91.36%, and the accuracy of 90.5 pg/ml, 110.5 pg/ml and 120.5 pg/ml were 89.88%, 90.51% and 89.18%, respectively. Fungal culture was positive in 636 cases and negative in 787 cases. The content of G in the IFI group and non-IFI group were (532.83 ± 778.67) pg/ml, with the significant difference (t = 15.208, P < 0.001). In the IFI group, Candida infection group, Penicillium marneffei infection group, cryptococcal infection group, Candida albicans and Penicillium marneffei mixed infection group G test were (444.29 ± 705.44) pg/ml, (452.78 ± 511.40) pg/ml, (89.56 ± 71.58) pg/ml and (596.28 ± 840.23) pg/ml. G test content of cryptococcal infection with Candida infection (t = 6.581, P < 0.001), Penicillium marneffei infection (t = 6.889, P < 0.001) and Candida and Penicillium marneffei co-infection (t = 4.865, P < 0.001), with significant differences. The sensitivity of G test and fungal culture method were 84.35% and 70.75%, with significant differences (χ² = 5.331, P = 0.021). The specificity of G test and fungal culture method were 96.29% and 73.65%, with significant differences (χ² = 20.067, P < 0.001). The two method combined detection sensitivity was 96.43%, and the specificity was 70.54%.

In patients with HIV/AIDS diagnosis of IFI G test fungal culture method was simple, rapid, high positive rate and high specificity. Continuous monitoring of G test was helpful to improve the diagnostic efficiency of IFI; the combined detection could improve the diagnosis efficiency of Pneumocystis and Cryptococcus, early prediction and diagnosis of Penicillium marneffei infection.