血清半乳甘露聚糖诊断恶性血液病并发侵袭性真菌感染的应用价值

Utility of serum galactomannan in diagnosis of invasive fungal infection in hematologic malignancy

目的应用半乳甘露聚糖(GM)试剂盒检测恶性血液病并发侵袭性真菌感染(IFI)高危因素患者的血清GM值,评价其对IFI的诊断、疗效预测价值。方法采集83例具有IFI高危因素患者的254份血清,按GM检测试剂盒说明ELISA法检测抗真菌治疗前后GM抗原水平变化。参照IFI分层诊断标准进行评价。结果GM阳性患者36例,其中确诊组3例、临床诊断组5例、拟诊组23例、不符合IFI组5例,阳性率分别为75%、63%、51%和19%;本次GM试验灵敏度0.67,特异度0.81,阳性预测值0.62,阴性预测值0.84;GM阳性患者选择覆盖曲霉的抗生素治疗有效率62%,治疗前、后GM平均值各为1.65±0.85和0.58±0.30,P<0.05;而用氟康唑治疗有效率仅为25%。GM阴性患者采用氟康唑或两性霉素B、伊曲康唑均可,各药物间疗效无明显差别,治疗前、后平均GM值各为0.25±0.10和0.26±0.20,P>0.05。结论GM试验灵敏度中等、特异度较高,高危患者结合临床表现,GM试验检测阳性应立即抗曲霉治疗,动态检测GM值变化可有效判断治疗效果。

Objective To evaluate the value of serum galactomannan （GM） Platelia Aspergillus Kit in the diagnosis and prediction of invasive fungal infection （IFI） in patients with hematologic malignancy. Methods A total of 254 serum samples from 83 high risk patients were collected. ELISA assay was used to analyze the change of GM antigen. Results According to the certainty level of IFI diagnosis, 3, 5, 23 and 5 patients were identified as GM positive in proven, probable, possible and improbable IFI groups respectively. The prevalence of GM in these 4 groups was 75%, 63%, 51% and 19%, respectively. The sensitivity and specificity of galactomannan ELISA assay were 67% and 81 % respectively. The positive and negative predictive values were 62 % and 84 % respectively. The efficacy of amphotericin B or itraconazole in GM-positive patients was superior to that of fluconazole. In GM-negative patients, the efficacy of these three drugs did not show significant difference. After antifungal therapy, the average OD value of GM-positive patients decreased from 1.65 ± 0.85 to 0.58 ± 0.30 （P〈0.05）. But in GM negative patients, the value was 0.25 ± 0.10 and 0.26 ± 0.20, respectively （P〉0.05）. Conclusions The sensitivity of galactomannan ELISA assay is moderate, but with high specificity. The high risk patients whose GM test is positive should begin antifungal therapy immediately. However, negative result can not exclude IFI. The change of GM values can be considered as a reliable index to predict the antifungal effect.