赣南医科大学学报

目的：评估免疫荧光染色法在下呼吸道真菌感染诊断中的临床价值。方法：选取2020年1月1日至2024年12月31日在赣南医科大学第一附属医院临床确诊肺部真菌感染的住院患者2 224例，回顾性分析患者肺泡灌洗液经免疫荧光染色法、革兰氏染色法的检测结果，分别计算2种检测方法的检出率、准确度、灵敏度、特异度、阳性预测值和阴性预测值等诊断指标。结果：共获得肺泡灌洗液样本2 224份，其中采用免疫荧光染色法检测的样本为911份，其检出率为25.47%，准确度为51.37%，灵敏度为25.75%，特异度为74.79%，阳性预测值为48.28%，阴性预测值为52.43%；采用革兰氏染色法检测的样本为1 313份，其检出率为4.95%，准确度为55.67%，灵敏度为6.11%，特异度为95.99%，阳性预测值为55.38%，阴性预测值为55.69%。肺泡灌洗液样本采用免疫荧光染色法检测的检出率、灵敏度高于革兰氏染色法，准确度、特异度低于革兰氏染色法，差异均有统计学意义（P<0.05）；阳性预测值、阴性预测值低于革兰氏染色法，但差异无统计学意义（P>0.05）。结论：肺泡灌洗液免疫荧光染色法能快速而准确地判断真菌，漏诊风险低，在确诊下呼吸道真菌感染中有重要的临床价值。

Objective : To evaluate the clinical value of immunofluorescence staining in the diagnosis of lower respiratory tract fungal infections. Methods : Data of 2 224 inpatients with clinically confirmed pulmonary fungal infections in the First Affiliated Hospital of Gannan Medical University between January 1, 2020, and December 31, 2024 were selected. The detection results of alveolar lavage fluid by immunofluorescence staining and Gram staining were retrospectively analyzed. The detection rate, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the two detection methods were calculated respectively. Results : A total of 2 224 alveolar lavage fluid samples were obtained, among which 911 samples were stained by immunofluorescence staining, with a detection rate of 25. 47%, accuracy of 51. 37%, sensitivity of 25. 75%, specificity of 74. 79%, positive predictive value of 48. 28%, and negative predictive value of 52. 43%. A total of 1 313 samples were stained by Gram staining, with a detection rate of 4. 95%, accuracy of 55. 67%, sensitivity of 6. 11%, specificity of 95. 99%, positive predictive value of 55. 38%, and negative predictive value of 55. 69%. The detection rate and sensitivity of alveolar lavage fluid samples stained by immunofluorescence staining were higher than those stained by Gram staining, while the accuracy and specificity were not higher than those stained by Gram staining, and the differences were statistically significant(P<0. 05). The positive and negative predictive values were lower than those of Gram staining, but there was no significant difference(P>0. 05). Conclusion : Immunofluorescence staining of alveolar lavage fluid can quickly and accurately identify fungi with a low risk of missed diagnosis, and has important clinical value in the diagnosis of lower respiratory tract fungal infections.