血清Mplp抗原检测对艾滋病合并马尔尼菲蓝状菌病的诊断价值

Diagnostic value of serum Mplp antigen detection for Talaromyces marneffei infection in acquired immune deficiency syndrome patients

目的探讨马尔尼菲蓝状菌特异性甘露糖蛋白Mplp抗原检测在诊断艾滋病合并马尔尼菲蓝状菌病中的应用价值。方法2012年1月至2015年6月广州市第八人民医院收治的艾滋病合并马尔尼菲蓝状菌病患者184例，经病原学检测均马尔尼菲蓝状菌阳性；对照组205例包括艾滋病未合并马尔尼菲蓝状菌病患者176例和健康对照者29名。使用双抗体夹心ELISA法和荧光免疫层析技术结合双抗体夹心法检测血清Mplp抗原，分析其对诊断艾滋病合并马尔尼菲蓝状菌病的灵敏度与特异度。统计学处理采用Х^2检验和t检验。结果艾滋病合并马尔尼菲蓝状菌病患者与对照组性别和年龄比较差异无统计学意义（Х^2=0．019，P—o．889；t=1．810，P=0．07）。双抗体夹心ELISA法和荧光免疫层析技术结合双抗体夹心法诊断艾滋病合并马尔尼菲蓝状菌病的灵敏度分别为82．07％（151／184）和83．15％（153／184），两种方法比较差异无统计学意义（Х^2=0．076，P=0．783）；特异度分别为93．17％（191／205）和92．68％（190／205），两种方法比较差异无统计学意义（Х^2=0．037，P=0．847）；准确度分别为87．92％（342／389）和88．17％（343／389），两种方法比较差异无统计学意义（Х^2=0．012，P=0．912）；假阳性率分别为6．83％（14／205）和7．32％（15／205），假阴性率分别为17．93％（33／184）和16．85％（31／184），两种方法比较差异无统计学意义（Х^2=0．049，P=0．829）；阳性预测值分别为91．52％（151／165）和91．07％（153／168），两种方法比较差异无统计学意义（Х^2=0．021，P=0．886）；阴性预测值分别为85．27％（191／224）和85．97％（190／221），两种方法比较差异无统计学意义（Х^2=0．045，P=0．832）；Kappa值分别为0．83和0．80。结论血清马尔尼菲蓝状菌Mplp抗原检测的特异度和敏感度较高，可用于早期快速诊断艾滋病合并马尔尼菲蓝状菌病。

Objective To explore the diagnostic value of Talaromyces marneffei （T. rnarneffei）- specific mannose glycoprotein Mplp antigen for T. rnarneffei infection in acquired immune deficiency syndrome （AIDS） patients. Methods All cases were recruited in this study from January 2012 to June 2015 in Guangzhou No. 8 People＇s Hospital, including 184 AIDS patients with 7＂. rnarneffei infection confirmatively diagnosed by culture, and 205 controls including 176 AIDS patients without T. rnarneffei infection and 29 health controls. Double antibody sandwich enzyme linked immunosorhent assay and fluoroimmunoassay combined with double-antibody sandwich were both utilized to detect serum Mplp antigen levels, and their sensitivity and specificity for diagnosing T. marneffei infection in patients with AIDS were analyzed. Zztest and t test were used for statistical analysis. Results The ratio of males to females and age of the study group were both comparable to those of the control group （Х^2 =0. 019, P=0. 889 t= 1. 810, P = 0.07, respecitvley）. The sensitivities of double antibody sandwich enzyme linked immunosorbent assay and fluoroimmunoassay combined with double-antibody sandwich were 82. 070//00 （151/184） and 83.15% （153/184）, respectively （Х^2 =0. 076, P=0. 783）. The specificities were 93.17% （191/205） and 92. 68% （190/205）, respectively （Х^2=0. 037, P=0. 847）. The accuracy values were 87.92%（342/389） and 88. 17% （343/389）, respectively （Х^2=0.012, P=0. 912）. The false positive rates were 6.83% （14/205） and 7.32% （15/205）, respectively. The false negative rates were 17.93% （33/184） and 16.85% （31/184）, respectively （22 = 0. 049, P= 0. 829）. The positive predictive values were 91.52%（151/165） and 91.07%0 （153/168）, respectively （Х^2=0.021, P=0.886）. The negative predictive values were 85.27%（191/224） and 85.97%（190/221）, respectively （i^2 =0. 045, P=0. 832）. The Kappa values were 0.83 and 0.80, respectively. Conclusion Detection of serum Mplp antigen of T. marneffei possesses high specificity and sensitivity, which may be utilized for rapid and early diagnosis of T. marneffei infection in patients with AIDS.