血浆(1,3)-β-D-葡聚糖抗原检测对器官移植术后患者侵袭性肺部真菌感染的诊断价值

Clinical evaluation of(1,3)-β-D-glucan measurement for diagnosis of invasive pulmonary fungal infections in organ transplant recipients

目的探讨血浆（1，3）-β-D-葡聚糖（BG）检测（G试验）在早期诊断器官移植术后合并侵袭性肺部真菌感染（IPFI）的敏感性与特异性。方法2006年1月-2008年2月在本院器官移植中心接受器官（或组织）移植合并有肺部病变的患者60例，分别为接受造血干细胞移植（HSCT）、肾移植和肝移植。入选患者在住院期间每周采集2次全血，进行血浆G试验和血清曲霉菌半乳甘露聚糖抗原（GM）检测。10例健康志愿者均采血1次。结果32例确诊和临床诊断IPFI患者共采集35株致病型真菌，主要为曲霉菌（22株）；有12例患者G试验结果为阴性。单份血浆标本G试验阳性的敏感性为60%～71．4％，特异性为74．796-89．7％，连续双份血浆标本G试验阳性的敏感性（40％-57．1％）略有降低，但特异性（86．7％～98．3％）有所升高。G试验较痰液真菌培养平均提前8．2d出现阳性结果，差异有显著统计学意义（P〈0．01）。较典型影像学改变也平均提前3d（P〈0．05）。结论通过连续检测血浆BG浓度，G试验对器官移植术后合并IPFI的诊断敏感性接近60％，特异性则达到98％；且较微生物学培养及典型影像学改变更早出现阳性结果。

Objective To evaluate the utility of （1, 3）-β-D-glucan （BG） t for the diagnosis of invasive pulmonary fungal infections （IPFI） in organ transplant recipients. Methods Sixty patients after organ transplantation with pulmonary infections and ten healthy donors were enrollecL Serum and plasma samples from patients were collected twice every week for BG and galactornannan（GM） tests. Results 32 patients were diagnosised with proven and probable IPFI according to EORTC/MSG criteria. 35 strains of pathogenic fungi were obtained from blood or low airway secretion, including 22 strains of Aspergillus and 3 strains of Candida. All the 10 blood donors and 12 of 32 IPFI patients were BG negative. The sensitivity and specificity of single BG positive were 60% --71.4% and 74.7% --89.7%. The sensitivity and specificity of consecutive BG positive were 40 % -- 57.1% and 86.7 % -- 98.3 %. The result of BG positive arose earlier than sputum fungal culture by 8.3 days （P〈0.01） and so did typical radiology change by 3 days （P〈0. 05）. Conclusions The sensitivity and specificity of consecutive BG test were almost 60 % and 98 % respectively for diagnosis of IPFI in organ transplant recipients. The positive result of BG was earlier than culture and radiology.