GM值在高危真菌感染风险的血液病患者诊断驱动治疗中的临床意义

Clinical significance of galactomannan value in patients with hematological diseases and high risk of pulmonary invasive fungal infection during diagnostic-driven therapy

目的:探讨在高危肺侵袭性真菌感染风险的血液病患者诊断驱动治疗中,半乳甘露聚糖(GM)值对疗效及预后的临床意义,为GM试验的临床应用提供新的思路。方法:自2015年1月1日至2019年5月30日,对就诊于北京大学第三医院血液科的104例行诊断驱动治疗患者的临床资料进行回顾性分析。结果:多因素回归分析提示患者GM值、最高体温、年龄与治疗结局相关。GM值≥2μg/L与GM值<2μg/L的病死率分别为44.83%、22.67%(P=0.025)。接受广谱三唑类一线治疗与接受棘白菌素类一线治疗患者的病死率分别为16.9%、58.3%(P=0.00016)。结论:在肺侵袭性真菌感染高危血液病患者诊断驱动治疗中,高GM检测值提示预后不良,以2μg/L作为GM试验的界值指导治疗具有积极的意义,采用广谱三唑类抗真菌治疗可能有更好的疗效。

Objective:To explore the clinical significance of galactomannan(GM)value in the prediction of curative effects and prognosis of patients with hematological diseases and high risk of pulmonary invasive fungal infection during diagnostic-driven therapy,and to provide a new idea for clinical application of GM test.Methods:From January 1,2015 to May 30,2019,the clinical data of 104 patients receiving diagnostic-driven therapy in the Department of Hematology,the Third Hospital of Peking University were retrospectively analyzed.Results:Multivariate regression analysis showed that GM value,maximum body temperature and age were related to treatment outcome.The fatality rates of patients with GM≥2μg/L and GM<2μg/L were 44.83%and 22.67%,respectively(P=0.025).The fatality rates of patients receiving broad-spectrum triazoles and echinocandins were 16.9%and 58.3%,respectively(P=0.00016).Conclusion:During diagnostic-driven therapy for patients with hematological diseases and high risk of pulmonary invasive fungal infection,high GM value indicates poor prognosis.Taking 2μg/L as the cut-off value of GM test to guide the treatment has positive significance,and broad-spectrum triazole antifungal therapy may have better curative effect.