半乳甘露聚糖试验对侵袭性曲霉病诊断价值的回顾性分析

Retrospective analysis the diagnostic value of Platelia Aspergillus enzyme immunoassay for invasive aspergillosis

目的回顾性分析Platelia Aspergillus EIA法检测血清半乳甘露聚糖（GM）对侵袭性曲霉病（IA）的诊断价值。方法根据诊断标准回顾性地将诊断分为确诊、临床诊断、拟诊及排除IA，并根据患者的基础疾病及是否接受影响免疫功能的药物分为：恶性血液病及造血干细胞移植术后（HSCT）组（A组），使用了影响免疫功能药物但非恶性血液病及HSCT患者组（B组），非恶性血液病及HSCT且未使用影响免疫功能药物的患者组（C组），分析GM实验在各组患者中的以及总的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。结果781例患者，最终确诊8例，临床诊断33例，拟诊189例，排除IA551例。230例不能排除真菌感染的患者中160例GM阳性，阳性率69．6％，其中确诊6例，临床诊断24例，拟诊130例。GM实验总的敏感性、特异性、NPV分别为73．2％、81．7％、97．6％。在不同类型的患者中敏感性和特异性存在差异，A组的敏感性、特异性分别为85．7％、88．4％，B组为81．2％、81．4％，C组为45．5％、78．7％；不同类型的患者GM试验结果吸光率指数（AI）的中位数分别为A组2．78，B组1．82，C组0．585；A组、B组与C组的敏感性、特异性和AI值分布上有显著差异（P〈0．05）。至少68．0％真菌培养阳性患者GM阳性时间早于培养阳性2～11d。结论Platelia Aspergillus EIA法检测GM对IA高危患者尤其是恶性血液病及HSCT患者、使用了影响免疫功能药物的其他患者有早期诊断价值，连续监测患者的GM水平，有助于了解疾病的进展程度、对治疗的反应性及预后；但在非血液病且未使用影响免疫功能药物的患者中其诊断价值有限。

Objective To retrospective analysis the diagnostic value of Platelia Aspergillus enzyme immunoassay for invasive aspergillosis （IA）. Methods The diagnosis of IA was classified as proven or probable or possible or without IA according to the criteria, and the patients were classified as hematologic malignancies and hemotopoietic stem cell transplantation （HSCT） （group A）, non-group A and treated with immunosupressive agents（ group B）, non-group A and non-immunosupressive agents （group C）. The total sensitivity, specificity and negative predictive value of GM were calculated, and the difference of them among groups were analyzed. Results Of the 781 patients, 8 had proven IA, 33 had probable IA, 189 had possible IA, and 551 had no IA. The Among 230 patients with invasire fungal infection, 160 had positive results. The total sentivity, specificity and negative predictive value were 73.2% , 81.7%, 97.6%, respectively. The sensitivity and specificity were 85.7% and 88.4% in group A, 81.2% and 81.4% in group B, 45.5% and 78.7% in group C（ P 〈 0.05）. The median of GM positive results was 2.78 in group A, 1.82 in group B, 0. 585 in group C（P 〈 O. 05）. Conclusions Platelia Aspergillus enzyme immunoassay is a useful test for the early diagnosis of IA in patients at risk, especially in hematologic malignancies patients and HSCT recipients, and patients receiving immunosupressive agents. Regularly monitoring the kinetics of GM-EIA indices can provide useful information in disease progression, responsibility to therapy and outcome. But in patients without hematologic malignancies and non-immunosupressive agents, its value is limited.