实时荧光定量PCR在马尔尼菲篮状菌感染诊断与疗效监测中的临床价值

doi:10.19871/j.cnki.xfcrbzz.2026.03.005

新发传染病电子杂志 ›› 2026, Vol. 11 ›› Issue (3): 24-29.doi: 10.19871/j.cnki.xfcrbzz.2026.03.005

实时荧光定量PCR在马尔尼菲篮状菌感染诊断与疗效监测中的临床价值

刘夏^1#, 邹俊^1#, 卢亦波², 覃小英¹, 许秋娜³, 梁翠金¹, 赵蕊¹, 蓝健¹, 肖秋叶¹, 黄田¹, 韦垠朵¹, 覃金梅¹, 阳世雄⁴

1.南宁市第四人民医院/广西艾滋病临床治疗中心感染科,广西南宁 530023;
2.南宁市第四人民医院/广西艾滋病临床治疗中心放射科,广西南宁 530023;
3.玉林市红十字会医院感染科,广西玉林 537000;
4.南宁市第一人民医院外科,广西南宁 530022

收稿日期:2026-02-12 出版日期:2026-06-30 发布日期:2026-07-17
通讯作者: 阳世雄,Email：13557712816@163.com。
作者简介:#,共同第一作者
基金资助:
1.广西壮族自治区卫生健康委员会自筹课题（Z20211324）;2.广西壮族自治区中医药管理局自筹经费科研课题（GZZC2020453）;3.南宁市兴宁区发展改革和科学技术局重点研发计划（2022A11）

The research on the value of quantitative real-time PCR in the diagnosis and treatment monitoring of Talaromycosis marneffei infection

Liu Xia¹, Zou Jun¹, Lu Yibo², Qin Xiaoying¹, Xu Qiuna³, Liang Cuijin¹, Zhao Rui¹, Lan Jian¹, Xiao Qiuye¹, Huang Tian¹, Wei Yinduo¹, Qin Jinmei¹, Yang Shixiong⁴

1. Department of Infectious Diseases, HIV/AIDS Clinical Treatment Center of Guangxi (Nanning), The Fourth People's Hospital of Nanning, Guangxi Nanning 530023, China;
2. Department of Radiology, HIV/AIDS Clinical Treatment Center of Guangxi (Nanning), The Fourth People's Hospital of Nanning, Guangxi Nanning 530023, China;
3. Department of Infectious Diseases, Yulin Red Cross Hospital, Guangxi Yulin 537000, China;
4. Department of Surgery, The First People's Hospital of Nanning, Guangxi Nanning 530022, China

Received:2026-02-12 Online:2026-06-30 Published:2026-07-17

摘要/Abstract

摘要： 目的评估实时荧光定量聚合酶链反应（real-time quantitative PCR,qPCR）在马尔尼菲篮状菌（Talaromyces marneffei,T. marneffei）感染诊断及抗真菌治疗监测中的应用价值,为优化抗真菌治疗策略提供实验室证据。方法纳入2022年1月至6月于南宁市第四人民医院确诊的T. marneffei感染患者。以真菌培养为诊断金标准,纳入基线配对标本,通过比较qPCR与真菌培养的阳性率,评估qPCR诊断真菌感染的敏感度。采用Spearman相关分析评价基线菌载量与培养阳性所需时间的相关性。通过构建线性混合效应模型,分析抗真菌治疗过程中菌载量的变化规律。结果共纳入64例培养确诊的T. marneffei感染患者。患者基线血浆qPCR敏感度达95.3%（61/64）,高于同期血液培养（90.7%）和骨髓培养（91.7%）的阳性率。基线血浆菌载量与培养阳性所需时间呈显著负相关（r= -0.495, P<0.001）。治疗过程中,随治疗时间延长,菌载量呈显著下降趋势（β=-0.3216,P<0.001）,而不同治疗方案（含与不含两性霉素B）之间的菌载量下降差异无统计学意义（P=0.532）;患者间基线菌载量及治疗反应均存在明显个体异质性。在血培养转阴当日（治疗后第4~13天）,50例（78.1%）患者的qPCR检测同步转阴,但仍有14例（21.9%）血液qPCR持续阳性。结论 qPCR方法诊断T. marneffei感染具有高敏感度,可用于早期辅助诊断;治疗监测中可动态反映菌载量,能发现血培养转阴后仍存在的持续感染,有助于疗效评估及个体化治疗方案的调整。

关键词: 马尔尼菲篮状菌, 实时荧光定量聚合酶链反应, 菌载量, 诊断, 治疗监测

Abstract: Objective To evaluate the application value of real-time quantitative PCR (qPCR) in the diagnosis of Talaromyces marneffei (T. marneffei) infection and in the monitoring of antifungal therapy, and to provide laboratory evidence for optimizing antifungal treatment strategies. Method Patients with confirmed T. marneffei infection at the Fourth People's Hospital of Nanning from January to June 2022 were enrolled. Using fungal culture as the diagnostic gold standard, baseline paired specimens were collected. The sensitivity of qPCR for diagnosing fungal infection was evaluated by comparing the positive rates of qPCR and fungal culture. Spearman correlation analysis was used to assess the correlation between baseline fungal load and the time to positivity in culture. A linear mixed-effects model was constructed to analyze the changes in fungal load during antifungal therapy. Result A total of 64 culture-confirmed T. marneffei infected patients were included. At baseline, plasma qPCR demonstrated a sensitivity of 95.3% (61/64), exceeding the positivity rates of concurrent blood culture (90.7%) and bone marrow culture (91.7%). Baseline plasma fungal load was significantly and negatively correlated with the time to culture positivity (r=-0.495, P<0.001). During treatment, fungal load demonstrated a significant declining trend over time (β=-0.3216, P<0.001), whereas no statistically significant difference in the rate of fungal load decline was observed between treatment regimens with and without amphotericin B (P=0.532); substantial inter-individual heterogeneity was noted in both baseline fungal load and treatment response. On the day of blood culture conversion to negative (days 4-13 after treatment initiation), qPCR results simultaneously converted to negative in 50 patients (78.1%), while 14 patients (21.9%) remained qPCR-positive in blood. Conclusion The qPCR method demonstrates high sensitivity for diagnosing T. marneffei infection and can be used for early auxiliary diagnosis. In treatment monitoring, qPCR can dynamically reflect changes in fungal load and can identify patients with persistent infection even after blood cultures have become negative, thereby facilitating efficacy assessment and adjustment of individualized therapy.

Key words: Tuberculous cervical lymph nodes, Metastatic lymph nodes, Ultrasound radiomics, Differentiation, Diagnosis

中图分类号:

R519.9

刘夏, 邹俊, 卢亦波, 覃小英, 许秋娜, 梁翠金, 赵蕊, 蓝健, 肖秋叶, 黄田, 韦垠朵, 覃金梅, 阳世雄. 实时荧光定量PCR在马尔尼菲篮状菌感染诊断与疗效监测中的临床价值[J]. 新发传染病电子杂志, 2026, 11(3): 24-29.

Liu Xia, Zou Jun, Lu Yibo, Qin Xiaoying, Xu Qiuna, Liang Cuijin, Zhao Rui, Lan Jian, Xiao Qiuye, Huang Tian, Wei Yinduo, Qin Jinmei, Yang Shixiong. The research on the value of quantitative real-time PCR in the diagnosis and treatment monitoring of Talaromycosis marneffei infection[J]. Electronic Journal of Emerging Infectious Diseases, 2026, 11(3): 24-29.

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实时荧光定量PCR在马尔尼菲篮状菌感染诊断与疗效监测中的临床价值

The research on the value of quantitative real-time PCR in the diagnosis and treatment monitoring of Talaromycosis marneffei infection

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