HSCT后应用血清半乳甘露聚糖试验诊断侵袭性真菌感染113例报告

Clinical analysis of serum galactomannan test for diagnosis of invasive fungal infection after HSCT in 113 paitents

目的探讨造血干细胞移植（HSCT）后采用血清半乳甘露聚糖（GM）试验对侵袭性真菌感染（IFI）的早期诊断价值。方法回顾性分析113例HSCT受者的临床资料，根据诊断标准将受者分为确诊组、临床诊断组、拟诊组及非IFI组，应用统计软件分析GM试验的各项评价指标，发生IFI的危险因素，以及抗真菌治疗的疗效及其与GM试验的相关性。结果113例受者中，GM试验阳性共有45例，总阳性率39．S％（45／113）；确诊和临床诊断IFI的39例受者中，GM阳性31例（79．5%）。GM试验的敏感性为79．5％，特异性为86．2％，假阳性率13．8％，假阴性率20．5％，阳性预测值79．5％，阴性预测值86．5Yo，诊断符合率83．5％，Youden指数0．66。另外，发现GVHD、粒细胞缺乏及既往有真菌感染病史是发生IFI的危险因素，而原发病为急性粒细胞性白血病和急性淋巴细胞性白血病两组IFI的发生率有显著性差异（P〈0．05）。抗真菌治疗的总体有效率为52．7％，其中确诊和临床诊断IFI者的有效率为66．7％，治疗前GM阳性者在治疗后GM值有明显的降低（P〈0．05），且GM检测阳性者开始治疗的时间越早，治疗效果越好。结论GM试验对HSCT后IFI具有较好的早期诊断价值，动态监测GM水平变化可以作为评价抗真菌治疗效果的指标。

Objective To evaluate the value of serum galactomannan （GM） test for early diagnosis of invasive fungal infection （IFI） in HSCT patients. Method The clinical data were analysed retrospectively in 113 recipents subject to HSCT. According to domestic IFI diagnostic criteria, recipents were divided into proven IFI, probable IFI, possible IFI and non-IFI groups. The statistical software was used to calculate the sensitivity, specificity and predictive values. The risk factors of IFI and the efficacy of antifungal treatment were analyzed. The correlation between IFI and GM test was evaluated. Results Fourty-five patients （39. 8%） were considered GM test positive from a total of I13 cases, and 39 patients were diagnosed as proven or probable IFI. Thirty-one cases of IFI （79. 50%, 31/39） were identified by GM test. The sensitivity, specificity, false positive rate and false negative rate were 79. 5% ,86. 2%, 13.8%, 20. 5% respectively. The positive and negative predictive values were 79. 5% and 86. 5% respectively. The diagnose accordance rate was 83.5%, and the Younden index was 0. 66. Moreover, GVHI）, agranulocytosis and history of fungal infection were risk factors for IFI, and there was significant difference in the incidence of IFI between patients with primary disease of AML and those with ALL （P〈0. 05）. The total effective rate was 52. 7%. The effective rate of the patients with proven and probable diagonisis was 66. 7%. In addition, the GM value in paitents before antifungal treatment was significantly lower than that after treatment （P〈 0. 05）, and the sooner the treatment began when GM test was positive, the better the effectiveness. Conclusion GM test is a useful method for early diagnosis of IFI in HSCT recipients. The dynamic monitoring of GM level can be useful for assessing therapeutic reponse.