胶体金免疫层析法检测隐球菌荚膜抗原的诊断价值及隐球菌病患者的临床特征分析

Diagnostic value of colloidal gold immunochromatography for detecting cryptococcal capsule antigen and clinical characteristics in cryptococcal disease patients

目的探讨胶体金免疫层析法(CrAg-LFA)检测隐球菌荚膜抗原在隐球菌病中的诊断价值,并分析隐球菌病患者的临床特征。方法回顾性分析2018年6月至2020年6月于南京医科大学第一附属医院进行CrAg-LFA检测的住院患者共1623例。计算CrAg-LFA对隐球菌病诊断的灵敏度、特异度、阳性预测值和阴性预测值。同时,分析隐球菌病患者的一般资料、临床表现、实验室检查及治疗。结果1623例研究对象中最终诊断为隐球菌病的患者共46例,其中41例为肺隐球菌病,隐球菌脑膜炎2例,播散性隐球菌病、隐球菌败血症及髂骨隐球菌感染各1例。CrAg-LFA对隐球菌病诊断的灵敏度为84.8%,特异度为99.4%。其中,血清CrAg-LFA在肺隐球菌病诊断中的灵敏度为85.4%,特异度为100.0%,阳性预测值为100.0%,阴性预测值为99.6%;脑脊液CrAg-LFA检测在隐球菌脑膜炎诊断中的灵敏度和特异度均为100.0%。46例隐球菌病患者中有基础疾病的共30例(65.2%)。有55.6%的肺隐球菌病患者出现了总IgE的升高。结论CrAg-LFA检测在隐球菌病的诊断中具有重要的临床价值,对隐球菌病患者的临床特征进行分析可指导用药并评估预后。

Objective To investigate the diagnostic value of capsule antigen with colloidal gold immunochromatography(CrAg-LFA)for cryptococcal disease,and to analyze the clinical characteristics of patients with cryptococcal disease.Methods A retrospective analysis was performed on 1623 inpatients who underwent CrAg-LFA test from June 2018 to June 2020 in the First Affiliated Hospital of Nanjing Medical University.The sensitivity,specificity,positive predictive value and negative predictive value of CrAg-LFA in the diagnosis of cryptococcal disease were calculated.Meanwhile,the general data,clinical performance,laboratory examination and treatment of patients with cryptococcal disease were analyzed.Results A total of 46 patients with cryptococcal disease were diagnosed in 1623 subjects,including 41 patients with pulmonary cryptococcosis,2 with cryptococcal meningitis,1 with disseminated cryptococcosis,sepsis and iliac bone lesions caused by cryptococcal infection.The sensitivity of CrAg-LFA in the diagnosis of cryptococcal disease was 84.8%,and the specificity was 99.4%.The sensitivity,specificity,positive predictive value and negative predictive value of serum CrAg-LFA in the diagnosis of pulmonary cryptococcosis were respectively 85.4%,100.0%,100.0%and 99.6%,while the sensitivity and specificity of cerebrospinal fluid CrAg-LFA was 100.0%in the diagnosis of cryptococcal meningitis.Among 46 patients with cryptococcal disease,30 patients(65.2%)had underlying diseases.Total IgE was increased in 55.6%of patients with pulmonary cryptococcosis.Conclusion The detection of CrAg-LFA has important clinical value in the diagnosis of cryptococcal disease.Analysis of clinical characteristics of cryptococcal disease patients can guide the use of drugs and evaluate the prognosis.