半乳甘露聚糖检测对侵袭性曲霉病早期诊断的研究

Detection of Galactomannan for the Early Diagnosis of Invasive Aspergillosis

目的评价酶联免疫吸附法(ELISA)连续检测血清半乳甘露聚糖(galactomannan,GM)抗原对侵袭性曲霉病(in-vasive aspergillosis,IA)早期诊断和疗效监测中的价值。方法92例白血病和造血干细胞移植(hematopoietic stem celltransplants,HSCT)患者纳入实验研究,共测定标本290份。采用ELISA方法检测血清中的GM,检测浓度可达到0.5ng/ml。结果以1.5为阳性界值,GM检测的敏感性为60%,特异性100%,诊断符合率88%;以0.8为阳性界值,敏感性为90%,特异性95%,诊断符合率94%。连续监测时GM可早于真菌培养方法2～20d预测曲霉感染。在GM阳性患者中,对13例病人进行抗曲霉治疗,10例有效,3例无效死亡。抗曲霉治疗前GM水平呈缓慢上升趋势,保持在较高水平,抗真菌治疗有效病人的GM含量呈下降趋势,无效死亡病人呈上升趋势。结论血清GM检测是对白血病和HSCT患者IA的早期诊断和疗效评价的有用指标。

Objective To assess early diagnosis and follow-up value of galactomannan （GM） serially determination by ELISA method in invasive aspergillosis（IA）. Methods 290 blood samples were obtained from 92 patients with leukemia and recipients of hematopoietic stem cell transplants （HSCTs）. A sandwich enzyme-linked immunosorbent assay capable of detecting GM at concentrations as low as 0. 5 ng/ml has been recently developed. Results In the studies of profoundly leukemia and HSCTs patients on fluconazole prophylaxis, the GM ELISA method had high sensitivity （60% and 90%）, specificity（95% and 100%） and diagnosis rate（88% and 94%） when the positive predictive value were assigned to 1.5 and 0.8. When serially monitored ,the GM assay preceded diagnosis of aspergillus spp. cuhure methods by an average of 2-20 days, 13 of GM assay positive patients were given antiaspergillus therapy. There was a good response in 10 patients but no response in 3 cases. Declining GM concentrations had beenobserved in patients who responded to antifungal therapy,rising concentrations in those with fatal outcomes. Conclusion Detection of GM ELISA may be useful,not only for diagnosing the IA,but also for assessing the effectiveness of therapy in patients with leukemia and HSCTs.