侧向层析法检测隐球菌荚膜多糖抗原在隐球菌感染诊断中的临床价值

Clinical value of cryptococcal capsular polysaccharide antigen detection by lateral chromatography in the diagnosis of cryptococcal infection

目的了解隐球菌荚膜多糖抗原侧向层析法在临床检出隐球菌感染所致疾病的性能,为临床筛查隐球菌感染选择检验项目提供更好依据。方法收集四川大学华西医院2018年送检隐球菌荚膜多糖抗原病例资料。分析侧向层析法检测患者隐球菌荚膜多糖抗原对隐球菌感染所致疾病的灵敏度、特异度、阳性预测值、阴性预测值。对侧向层析法检出阳性并有明确临床诊断的样本与该例患者送检的墨汁染色法、真菌培养法结果进行比较分析。结果共检测721例。侧向层析法检测荚膜多糖抗原诊断隐球菌感染的灵敏度、特异度、阳性预测值、阴性预测值分别为100.00%、99.39%、93.93%、100.00%;墨汁染色法、真菌培养法及侧向层析法检测隐球菌感染的阳性率分别是63.46%、48.00%、100.00%。62例患者已明确临床诊断,其中隐球菌性脑膜炎45例(72.58%),隐球菌肺炎16例(25.81%),骨隐球菌感染1例(1.61%)。结论隐球菌荚膜多糖抗原-侧向层析法在检出隐球菌感染所致疾病中敏感性和特异性均较高,对临床早期筛查及辅助诊断隐球菌感染有较好临床应用价值,且操作快速简便,对检测人员的经验要求不高,适合各等级医院开展。

Objective To investigate the diagnostic value of lateral chromatography for cryptococcal capsular polysaccharide antigen in cryptococcal infection. Methods The data of patients who detected cryptococcal capsular polysaccharide antigen in West China Hospital of Sichuan University in 2018 were collected. The sensitivity, specificity,positive predictive value and negative predictive value of cryptococcal capsular polysaccharide antigen detected by lateral chromatography were analyzed. The samples with positive lateral chromatography and definite clinical diagnosis were compared with the results of ink staining and fungal culture. Results A total of 721 cases were detected. The sensitivity,specificity, positive predictive value and negative predictive value of lateral chromatography detection were 100.00%,99.39%, 93.93%, 100.00%, respectively. The positive rates of ink staining, fungal culture and cryptococcal capsular polysaccharide antigen for cryptococcal infection were 63.46%, 48.00% and 100.00%, respectively. Sixty-two patients were clinically diagnosed, including 45 cases of cryptococcal meningitis(72.58%), 16 cases of cryptococcal pneumonia(25.81%), and 1 case of bone cryptococcal infection(1.61%). Conclusions Lateral chromatography detection for cryptococcal capsular polysaccharide antigen shows well performing sensitivity and specificity in the diagnosis of cryptococcal infection. Considering its rapid and simple pre-operation, cryptococcal capsular polysaccharide antigen detection with lateral chromatography has good application value for early diagosis of cryptococcal infection.