血清1,3-β-D葡聚糖和半乳甘露聚糖检测对造血干细胞移植受者侵袭性真菌感染的诊断意义

Serum galactomannan antigen assay and 1,3 beta-D-glucan assay in the diagnosis of invasive fungal infection after hematopoietic stem cell transplantation

目的:评价血清1,3-β-D葡聚糖(BDG)检测(G试验)和半乳甘露聚糖检测(GM试验)对造血干细胞移植(HSCT)受者侵袭性真菌感染(IFI)的诊断价值。方法:采用Platelia Aspergillus酶联免疫吸附试验(ELISA)试剂盒和GKT-5M Set动态真菌检测试剂盒对64例HSCT受者移植后每周2次同时进行血清GM试验和G试验,并根据欧洲癌症研究治疗组织/真菌病研究组(EORTC/MSG)的诊断标准定义临床诊断真菌感染病例,对两种检测方法的检测结果作ROC曲线分析,采用χ2检验对GM试验不同阳性阈值之间及GM与G试验之间诊断结果的一致性进行分析。结果:单次GMⅠ值>0.7和G试验BDG质量浓度>26.0pg/L分别为GM和G试验阳性折点时曲线下面积最大,两者灵敏度分别为87.0%、69.6%,特异度分别为92.7%%和85.4%。单次GMⅠ值>0.7与连续2次GMⅠ值>0.5的结果一致性较差(Kappa=0.308,P<0.05);GM与G试验结果的一致性较好(Kappa=0.446,P>0.05)。结论:GM试验和G试验是诊断IFI可靠的诊断方法,两者对IFI临床诊断意义的一致性较好;采用一次试验检测时,选择GM试验更为理想,且以单次GMⅠ>0.7作为阳性阈值为佳。

Objective To evaluate the role of serum galactomannan antigen assay （GM test） and 1,3 beta-D-glucan assay （G test） in the diagnosis of invasive fungal infection （IFI） in patients received hematopoietic stem cell transplantation （HSCT）.Methods Blood samples were collected twice a week consecutively from 64 patients received HSCT,serum GM test and G test were performed with Platelia Aspergillus EIA test kit and GKT-5M kit set,respectively.Clinical diagnosis of invasive fungal infection （IFI） was defined according to the criteria of European Organization for Research and Treatment of Cancer/Mycoses Study Group.The results of both tests were analyzed by receiver-operating characteristic （ROC） curve and the clinical significance of different cut off values of GM test and G test was analyzed by chi-square test.Results By ROC analysis,the cut off values of GM Ⅰ and G test were 0.7 and 26.0 pg/L,respectively,which gave the best AUC.The sensitivity and specificity of GM and G tests were 87.0%,69.6% and 92.7%,85.4%,respectively.The the result of GM test correlated well with that of G test （Kappa=0.446,P〉0.05）.However,GM Ⅰ〉0.7 and twice GM Ⅰ〉0.5 were not well correlated （Kappa=0.308,P〈0.05）.Conclusions Serum galactomannan antigen assay and 1,3 beta-D-glucan assay are reliable methods for the diagnosis of IFI in patients received HSCT.The results of these two tests were well correlated in the diagnosis of IFI.In case of performing only one test,we consider galactomannan antigen assay is more preferable with the optional cut off value of 〉0.7.