血清半乳甘露聚糖检测对侵袭性真菌病早期诊断的价值

The value of detecting serum galactomannan for early diagnosis of invasive fungal infection

目的应用半乳甘露聚糖(GM)试剂盒检测有侵袭性真菌感染(IFI)高危因素患者伴感染症状的血清GM值,评价其对IFI早期诊断和疗效评估的价值。方法回顾分析47例有IFI高危因素伴临床感染症状及GM检测阳性患者,抗真菌治疗前后GM抗原水平的变化,并结合胸部CT及病原学检查综合分析进行评价。GM检测为ELISA法。结果 66%患者出现影像学的改变,仅13%患者病原学检查阳性。AI值≥0.8和AI值≥1.5的2组患者,80%以上对非氟康唑的抗真菌治疗有效,而AI值≥0.5的患者仅具28%的有效率(P<0.05)。治疗前、后AI平均值各为1.71±1.20和0.47±0.28(P<0.01)。结论 GM试验可以作为IFI早期诊断的指标,高危患者结合临床可开始经验性抗真菌治疗,如结合影像学检查,更具针对性。动态检测GM值变化不但可有效判断治疗效果,也有助于对IFI的进一步确定。

Objective To appraise the value of detecting serum galactomannan（GM） with GM reagent kit for early diagnosis and efficacy estimation of patients with high risk factors of invasive fungal infection（IFI） and IFI infective symptoms.Methods In 47 patients with IFI high risk factors and clinic IFI infective symptoms,the change of GM antigen levels before and after anti-fungal therapy was analyzed retrospectively,and the chest CT was evaluated.GM antigen was measured by enzyme linked immunosorbent assay（ELISA） with platelia-aspergillus kit.Results The change of image appeared in 66% patients,and positive etiologic report appeared only in 13% patients.The effective rates of non-fluconazole antifungal treatment were 80% for patients with absorbance index（AI） ≥0.8 and AI ≥1.5,and 28% for AI ≥0.5（P0.05）.The average AI values before and after treatment were 1.71±1.20 and 0.47±0.28,（P0.01）.Conclusions GM test can be served as an index of IFI early diagnosis.Consulting clinical manifestation,the empiric anti-antifungal treatment should begin immediately in high-risk patients,more,it is aimed at IFI when combining with image examination.Dynamically detecting GM changes can not only effectively judge therapeutic effect but also be helpful in ascertaining IFI diagnosis.