血清半乳甘露聚糖与甘露聚糖检测侵袭性真菌病的诊断意义

Diagnostic value of serum galactomannan and mannans assay for the invasive fungal infectious disease

目的回顾性分析血清曲霉菌属半乳甘露聚糖(GM)抗原及假丝酵母菌属甘露聚糖(MA)抗原酶联免疫吸附试验(ELISA)检测方法,对侵袭性真菌病(IFD)诊断的可行性和诊断价值。方法选择2011年8月-2012年8月306例患者检测GM和MA抗原的血清标本,依据诊断标准,将患者分为确定诊断、临床诊断、拟诊侵袭性曲霉菌属(IA)/假丝酵母菌病(IC)及排除IA/IC等4个组;应用ELISA法检测血清GM和MA抗原,根据试验结果计算敏感度、特异度、阳性预测值、阴性预测值、诊断符合率。结果 GM试验以血清指数(I)≥0.5为阳性界值,306例患者中GM试验阳性30例,阳性率9.8%,GM试验的敏感度83.3%、特异度96.5%、阳性预测值66.7%、阴性预测值98.6%、诊断符合率95.4%;MA试验以血清样品浓度(C)≥125pg/ml为阳性界值,306例患者中MA试验阳性23例,阳性率7.5%,MA试验的敏感度60.7%、特异度97.8%、阳性预测值73.9%、阴性预测值96.5%、诊断符合率94.4%。结论血清GM和MA试验阴性者排除侵袭性真菌病的价值较大,阳性结果确诊侵袭性真菌感染的准确性较好,ELISA法检测血清GM和MA抗原对于IFD高危患者的诊断是可行的,该检测对IFD的诊断有实际意义。

OBJECTIVE To retrospectively analyze the diagnostic feasibility and diagnostic value of serum Aspergil-lus galactomannan （GM）and Candidamannan （MA）antigen enzyme-linked immunosorbent assay （ELISA）assay for the invasive fungal infectious diseases （IFD） .METHODS Based on the diagnostic criteria ,patients were divided to 4 groups ,such as defined diagnosis group ,clinical diagnosis group ,suspected diagnosed as IA/IC group ,and excluded IA/IC group .The serum MA and GM antigen of 306 patients were assayed with ELISA method during Aug .2011 to Aug .2012 .According to ELISA test to results ,the sensitivity ,specificity ,positive predictive value ,negative predictive value and diagnosis coincidence rate were calculated .RESULTS The serum index （I） ≥0 .5 of GM test was positive cutoff value ,among 306 cases of patients ,30 cases were positive to GM test ,the total positive rate of 9 .8% .The sensitivity ,specificity ,PPV ,NPV ,and diagnosis coincidence rate of GM were 83 .3% ,96 .5% ,66 .7% ,98 .6% and 95 .4% ,respectively .The serum sample concentration （C） ≥ 125 pg/ml of MA test was positive cutoff value ,among 306 cases of patients ,23 cases were positive to MA test with the total positive rate of 7 .5% .The sensitivity ,specificity ,PPV ,NPV ,and diagnosis coincidence rate of MA were 60 .7% ,97 .8% ,73 .9% ,96 .5% and 94 .4% ,respectively .CONCLUSIONS The negative result of GM and MA has significant value to exclude IFD ,the positive results of GM and MA have better accuracy for diagnosing of IFD .Assayed GM and MA antigen by ELISA are feasible for the high risk patients with IFD ,which have practical significance for diagnosis of IFD .