胶体金免疫层析法和乳胶凝集试验检测隐球菌荚膜多糖抗原对艾滋病继发隐球菌感染的诊断价值

Diagnostic value of lateral flow immunoassay and latex agglutination test in AIDS patients with cryptococcal infection

目的探讨胶体金免疫层析法(LFA)和乳胶凝集试验(LA)检测隐球菌荚膜多糖抗原对艾滋病患者继发隐球菌感染的诊断价值及治疗观察的临床意义。方法采用LFA和LA对艾滋病患者继发隐球菌感染治疗前后的脑脊液标本和血清标本行隐球菌荚膜多糖抗原检测,并与脑脊液墨汁染色和真菌培养进行比较,评价其诊断的灵敏度和特异度。同时动态观察治疗期间隐球菌荚膜多糖抗原滴度的变化,和LFA的干扰因素。结果 LFA和LA对脑脊液标本隐球菌检测的敏感度分别为97.73%和95.45%,血清标本的敏感度也分别为97.73%、95.45%;对脑脊液标本的特异性分别为95.83%、95.83%,对血清标本的特异性分别为89.39%和87.12%。艾滋病继发隐球菌感染患者脑脊液标本中的隐球菌荚膜多糖抗原滴度随着患者病情的好转而逐渐下降,治疗前后脑脊液和血清中荚膜抗原滴度差异均有统计学意义(t=6.309,P<0.001;t=6.814,P<0.001)。结论 LFA与LA适用于隐球菌脑膜脑炎患者的快速诊断;脑脊液隐球菌多糖荚膜抗原的动态监测对艾滋病患者继发隐球菌感染的疗效观察具有重要的参考价值。

Objective To explore the diagnostic value and clinical significance of lateral flow immunoassay(LFA)and latex agglutination test(LA)to detect cryptococcal capsular antigen in AIDS patients with cryptococcal infection.Methods The cryptococcal capsular antigen in CSF and serum were detected by LFA and LA,and compared with cerebrospinal fluid ink staining and fungal culture to evaluate its diagnostic sensitivity and specific degrees.The change of cryptococcal capsular antigen drop degree during treatment,and the interference factor of lateral flow immunoassay were observed dynamically.Results The sensitivity of LFA and LA for detection cryptococcus was 97.73%and 95.45%in cerebrospinal fluid specimens and serum specimen respectively.The specificity was 95.83% respectively in cerebrospinal fluid specimens and 89.39%,87.12% in serum specimen respectively.The cryptococcal capsular antigen drops of AIDS patients with cryptococcus infection in cerebrospinal fluid specimens fell gradually along with treatment.The difference of capsular antigen titer in cerebrospinal fluid and serum before and after treatment had statistical significance.Conclusion LFA and LA are suitable for the rapid diagnosis of cryptococcus meningoencephalitis patients.LFA can short detection time and be more simple to operate and confirm the results.Dynamic monitoring of cryptococcal capsular antigen in cerebrospinal fluid specimens has important reference value to observe the curative efficacy of AIDS patients with cryptococcal infection.