侵袭性真菌病的诊断:现状与展望

The diagnosis of invasive fungal diseases:current status and future perspectives

近二十年来,医学科学很多领域都取得重大进步。但全球范围内,侵袭性真菌病的发病率及死亡率却仍明显上升,严重威胁人类健康。侵袭性真菌病发病隐匿、临床表现不典型、治疗手段有限、病死率与致残率高,早期、特异的诊断对于改善预后意义重大。目前,以培养、病理为代表的形态学诊断方法虽有局限,但仍是侵袭性真菌病诊断的金标准;以G试验、GM试验、高分辨率CT为代表的新兴血清学及影像学诊断方法值得在临床大力推广;而以PCR技术为基础的核酸诊断技术方法前景光明,但其临床应用之路却仍任重而道远。联合使用并不断改良现有培养、病理等形态学诊断方法、血清学方法及先进影像学技术是提高侵袭性真菌病诊断水平的现实最佳途径。

During the last 20 years,significant progress had generated in numerous regions of medical science. However,the worldwide incidence or mortality of invasive fungal diseases （IFDs） are still increasing remarkably,and being a serious threat to human health. Absence of typically clinical manifestations and optimal therapy options of IFDs lead to high mortality and morbidity of these infections worldwide. So earlier and specific diagnosis can distinctly improve the prognosis of IFDs. Despite the limitations of the morphological methods,represented by culture or pathology,they are still the gold standard of diagnostic invasive fungal diseases at present. The serological and imaging test such as G/GM test or high resolution CT deserved to be vigorously promoted in the clinical diagnosis; Although its clinical application is still long way to go,nucleic acid diagnostics based on PCR technology is likely to have a bright perspectives. Currently,combination and improvement of the current methods such as morphological methods,serological methods and advanced imaging technology is the best and most realistic approach to the diagnosis of IFDs in clinics.