血清半乳甘露聚糖抗原检测对血液病患者侵袭性曲霉病的诊断及预后的价值

Utility of serum galactomannan antigen for diagnosis and follow-up of invasive aspergillosis in hematological patients

目的初步评价动态检测血清半乳甘露聚糖(GM)抗原水平对血液病患者侵袭性曲霉病(IA)的诊断价值及疗效。方法采用ELISA法连续检测172例白血病和进行造血干细胞移植或移植后患者的613份血清标本的GM浓度,GM试验阳性定义为连续2次不同时点检测A值>0.5或单次>0.7。对GM试验阳性的患者给予抢先抗曲霉治疗。结果按照试验中界定的界值,该诊断试验的的灵敏度为81.1%,特异度为88.2%。GM测定阳性55例,阴性117例,通过GM测定临床诊断IA者由37例增加至52例,55例GM阳性患者38例完成针对曲霉的抢先治疗,26例有效,12例无效死亡,病死率为31.6%。抗曲霉治疗前GM水平呈缓慢上升趋势,保持在较高水平;抗真菌治疗有效患者的GM含量呈下降趋势,无效死亡患者中呈上升趋势。结论血清GM检测可以为早期诊断IA提供有力证据,动态监测GM值变化趋势是评价疗效的有用指标。

Objective To assess the value of serial measurements of serum galactomannan （GM） antigen for early diagnosis and follow-up of invasive aspergillosis （IA）. Methods Serum GM level of 613 samples from 172 hematological patients was determined by Platelia Aspergillus double-sandwich enzyme linked immunosorbent assay. Positive GM result was defined as A index 〉0.5 in two consecutive measurements or 〉0.7 in one measurement. The patients were managed with proaetive antifungal therapy if GM test was positive. Results The sensitivity and specificity of the assay were 81.1% and 88.2%, respectively. The result was positive in 55 patients, and negative in 117 patients. The number of probable IA eases increased from 37 to 52 according to GM criteria. Of the 55 GM-positive patients, 38 were managed by proactive therapy against Aspergillus. Good response was achieved in 26 patients. And 12 （31.6%） died due to treatment failure. GM concentration was decreasing in patients who responded to antifungal therapy, but increasing in the patients with fatal outcomes. Conclusions Serum GM antigen is a reliable method for early diagnosis and treatment of IA. The dynamic change of GM level may be useful for assessing treatment response.