血清GM抗原检测在COPD合并肺曲霉菌病临床诊治的应用价值

Applicative Value of Circulating Galactomannan in Diagnosis and Treatment of COPD and Complicated by Pulmonary Aspergillosis

目的:探讨血清曲霉菌半乳甘露聚糖(GM)抗原酶联免疫吸附试验(ELISA)在COPD患者合并肺曲霉菌感染诊断的可行性和指导临床治疗的价值。方法:采用ELISA检测临床确诊或拟诊的COPD合并侵袭性肺曲霉菌病患者血清曲霉菌GM抗原水平后,将其中27例患者随机分为A组(13例)、B组(14例),均给予伏立康唑静脉与口服序贯治疗,在6、8、12周时评价临床疗效:A组检测血清GM抗原、临床特征、痰真菌培养及胸部CT;B组观察临床特征、痰真菌培养及胸部CT。结果:临床确诊或拟诊的侵袭性肺曲霉菌病32例,血清合并GM抗原阳性30例,其中27例患者给予伏立康唑治疗,治疗6周,A组治愈5例,显效6例,好转1例,有效率84.6%;B组治愈7例,显效4例,好转1例,有效率78.6%;治疗8周,A组治愈9例,显效3例,有效率92.3%;B组治愈7例,显效5例,好转1例,有效率85.7%;治疗12周,A组治愈10例,显效3例,有效率100.0%;B组治愈8例,显效5例,有效率92.9%;其中A组1例在11周时因原发性血小板减少死亡,B组1例在8周抗真菌治疗效果欠佳时放弃治疗,两组治疗有效率不同,差异有统计学意义。结论:曲霉菌GM抗原ELISA检测可用于早期临床诊断COPD合并侵袭性肺曲霉菌病;以截值≥0.5为阳性折点,给予先发抗真菌治疗有重要意义;定期连续观察血GM可用于肺曲霉菌治疗的病情监测,同时联合胸部CT、痰培养可用于抗真菌治疗的疗效评价。

Objective To evaluate the utility of the pulmonary aspergillus enzyme-linked immunosorbent assay （ELISA） for diagnosing and the early treatment of invasive pulmonary aspergillosis （IPA） in immunocompromised patients. Methods ELISA was performed to seri- ally for galactomarman （GM） in 32 pulmonary fungal infection patients. And 27 IpA Patients were grouped A AND B, according to investi- gate serially for galactomannan （GM）, were all administered with intravenous voricona.zole followed by voriconazole tablet sequential therapy. ]he clinical curative efficacy were investigated in 6,8,12 weeks. Results Positive result （cutoff1〉0. 5） was reported for 30 cases in 32 IPA Patients. A total of 27 cases were administered with intravenous voriconazole followed by voriconazole tablet sequential. 6 week： A group cure （n = 5） Excellence （n =6 ）, Improve （n = 1 ）, effective rate 84. 6% ; S group cure （n = 7）, Excellence （n =4 ）, Improve （n = 1 ）, effective rate 78.6%; 8week： A group cure （n =9） Excellence （n=3）, effective rate 92.3%; B group cure （n =7）, Excellence （n =5）, Improve （n = 1 ）, effective rate 85.7% ; 12 week： A group cure（ n = 10 ）, Excellence（n = 3）, effective rate 100. 0% ; B group cure （n =8）, Excel- lence （n=5）, effective rate 92.9%. One case died of thrombocytopenia in A group 11 week. One case was died of thrombocytopenia in A group 11 week. One case gave up therapy. Both pulmonary these two groups had high overall effective rates, and had significant differences in Group A and B（P 〈0.05）. Conclusion The pulmonary aspergillus enzyme-linked immunosorbent assay （ELISA） may use to diagnose the early treating invasive pulmonary aspergillosis （IPA） in immanocompromised patients. Patients with a positive test result should deserve preemptive antifimgal therapy in pulmonary aspergillosis （IPA） with immunocompromisie. To serially observe the galactomannan （GM）, sputum aspergillus cultures and chest computed tomography may play in important role in IPA.