血清半乳甘露聚糖对侵袭性真菌感染的早期诊断价值

Value of serum galactomannan assay for early diagnosis and treatment of invasive fungal infection patients

目的评价血清半乳甘露聚糖(GM)浓度测定对侵袭性真菌感染(IFI)高危因素患者早期诊断的价值。方法采集74例IFI高危因素患者的178份血清,采用双抗体夹心酶联免疫吸附分析(ELISA)法测定抗真菌治疗前后GM抗原水平。参照IF1分层诊断标准进行评价。结果 GM阳性患者24例,其中确诊组1例、临床诊断组9例、拟诊组10例和不符合IFI组4例,各组阳性率分别为50.0%、64.3%、34.5%和13.8%;本GM检测试验,灵敏度0.63,特异度0.86,阳性预测值0.71,阴性预测值0.81,诊断符合率0.78;GM阳性患者选择覆盖曲霉的抗真菌药物(两性霉素B、伊曲康唑和伏立康唑)治疗有效率58.8%,治疗前、后GM平均值各为1.3±0.34和0.72±0.24(<0.05);而用氟康唑治疗有效率仅为22.2%。GM阴性患者采用氟康唑或两性霉素B、伊曲康唑均可,疗效差异无统计学意义(>0.05);治疗前、后平均GM值各为0.22±0.15和0.23±0.19(>0.05)。结论 GM检测灵敏度中等、特异度较高。对早期诊断IFI有一定的临床意义。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 curative effect prediction of invasive fungal infection （IFI） patients. Methods A total of 178 serum samples from 74 high risk patients were collected. ELISA assay was used to analyze the change of GM antigen. Results According to the cer-tainty level of IFI diagnosis, 1, 9, 10 and 4 patients were identified as GM positive in proven,probable,possible and im-probable IFI groups respectively. The prevalence of GM in these 4 groups was 50%, 64%, 34% and 14%, respectively. The sensitivity and specificity of serum galactomannan assay were 0.63, 0.86, and 0.78 respectively. The positive and negative predictive values were 0.71 and 0.81 respectively. The diagnose accordance rate was 0.78. The efficacy of amphotericin B or itraconazole or Voriconazole 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 1.3±0.34 to 0.72±0.24 （ 0.05）. But in GM negative patients, the value was 0.22 ±0.15 and 0.23 ±0.19,respectively （ 0.05）.Inaddition,thechanceofoccurrence for nodus and mass, cavity andcrescentic sign, halo sign in GM-positive IFI patients was more than that in GM-negative patients. Conclusions The sensitivity of serum galactomannan assay is moderate,but with high specificity. It could be a more reliable method for early diagnosis of IFI. The change of GM values can be considered as a reliable index to predict the antifungal activity.