侵袭性肺曲霉病实验室检测方法的研究进展

Research progress in experimental diagnosis of invasive pulmonary aspergillosis

侵袭性肺曲霉病(invasive pulmonary aspergillosis,IPA)是指曲霉菌菌丝生长侵入肺实质而引起的感染性疾病,具有发病急性、进展迅速、病死率高的特点。长期中性粒细胞缺乏、血液系统恶性肿瘤发生、造血干细胞或实体器官移植、长期大剂量糖皮质激素或免疫抑制剂使用、遗传性或获得性免疫缺陷状态是感染侵袭性肺曲霉病的危险因素。早期诊断和及时治疗是良好预后的关键。但由于该病缺乏典型的临床表现,早期诊断尤为困难。传统的组织病理学、细胞病理学及分离培养的方法可以确诊IPA,但灵敏度低。近年来,一些非培养实验室检测方法逐渐得到应用,如半乳甘露聚糖(galactomannan,GM)试验、(1,3)-β-D葡聚糖(BDG)试验(G试验)、聚合酶链反应(polymerase chain reaction,PCR)技术、免疫层析侧流装置(lateralflow device,LFD)技术等,本文就此类检测方法诊断IPA作一综述。

Invasive pulmonary aspergillosis(IPA)is an infectious disease caused by aspergillus species which can invade the tracheal bronchus and lung directly while hyphae grow.It is an acute,most often fatal,rapidly progressing infection.Prolonged neutropenia,hematological malignancy,transplantation(hematopoietic stem cell transplantation and solid organ transplantation),prolonged corticosteroid therapy and immunosuppressant therapy,acquired immune deficiency syndrome(AIDS),and inherited immunodeficiency are risk factors for this disease.Early diagnosis and timely treatment are the keys to a better prognosis.However,because of the unspecific clinical manifestations,it is challenging to diagnose the disease early.Traditional methods such as histopathology and cytopathology examinations and isolated culture are of confirmed value,but with low sensitivity.In recent years,a number of non-culture laboratory diagnostic methods are being applied into practice,for example,galactomannan assay,polymerase chain reaction,andlateral-flow device,this review is about these novel diagnostic methods.