眼内液检测诊断白色念珠菌眼内炎的临床研究

Evaluation of the intraocular fluid detection for the diagnosis of endophthalmitis in patients infected by Candida albicans

目的评估酶联免疫吸附法(ELISA)检测眼内液中白色念珠菌特异性免疫球蛋白(Ig)G抗体和动态显色法G试验检测(1,3)-β-D-葡聚糖对白色念珠菌眼内炎的诊断价值。方法收集2020年5月至2021年4月于首都医科大学附属北京朝阳医院眼科、山西爱尔眼科医院眼科、郑州市第二人民医院眼科及内蒙古民族大学附属医院眼科就诊的9例(9只眼)白色念珠菌眼内炎者和10例(10只眼)非感染性眼病患者的病例资料进行回顾性分析。其中,男性13例(13只眼),女性6例(6只眼);年龄6~79岁,平均年龄(37.3±22.0)岁。将白色念珠菌眼内炎者定义为感染组;非感染性眼病患者定义为非感染组。采集所有患者单眼的房水和(或)玻璃体(统称为眼内液)。分别采用ELISA法和动态显色法检测眼内液中白色念珠菌IgG抗体和(1,3)-β-D-葡聚糖的含量。记录白色念珠菌眼内炎患者的临床症状和体征。患者临床症状和体征的分布情况采用例数和百分比表示;经检测获得的眼内液中白色念珠菌IgG抗体的含量和(1,3)-β-D-葡聚糖的含量以中位数和四分位数表示。结果感染组患者中男性6例(6只眼),女性3例(3只眼);年龄6~76岁,平均年龄为(37.5±17.7)岁。非感染组患者中男性7例(7只眼),女性3例(3只眼);年龄18~79岁,平均年龄(37.2±23.6)岁。感染组患者中内源性感染者8例(8只眼),占88.9%(8/9);外源性感染者1例(1只眼),占11.1%(1/9),为角膜穿通伤后继发感染。感染组送检房水和玻璃体者分别为2例(2只眼)和7例(7只眼),分别占22.2%(2/9)和77.8%(7/9);非感染组送检房水和玻璃体者分别为10例(10只眼)和0例,分别占100.0%(10/10)和0。感染组患者均因视力急剧下降就诊,自觉视物变形者2例(2只眼),占22.2%(2/9);有眼前黑影飘动者4例(4只眼),占44.4%(4/9)。患者视力从光感到0.5不等,眼部体征包括睫状充血、角膜后沉着物、房水闪辉、前房积脓、瞳孔后粘连、晶状体前色素沉着、玻璃体混浊以及位于视网膜上或视网膜下的白色病灶。感染组和非感染组患者眼内液中(1,3)-β-D-葡聚糖平均含量的中位数和四分位数分别为28.9(19.8,55.3)pg/ml和10(10,10)pg/ml。两组患者眼内液白色念珠菌IgG抗体平均含量的中位数和四分位数分别为2.8(0.7,89.5)U/ml和0.6(0.5,0.7)U/ml。眼内液G试验诊断的敏感度为88.9%,特异性为90%。白色念珠菌IgG诊断的敏感度为66.7%,特异性为100%。结论采用ELISA法检测眼内液中白色念珠菌IgG抗体和动态显色法G试验检测眼内液中(1,3)-β-D-葡聚糖的含量对疑似白色念珠菌眼内炎均有诊断参考价值。

Objective The aim of this study was to evaluate the diagnostic effectiveness of enzyme linked immunosorbent assay(ELISA)and kinetic chromogenic method(fungal G assay)in patients infected by intraocular Candida albicans.Methods The monocular anterior chamber fluid and(or)vitreous fluid(called for intraocular fluid samples)of were collected from 9 patients(9 eyes)with intraocular infection of Candida albicans and 10 cases(10 eyes)with non-infectious ocular diseases who registered in Department of Ophthalmology,Beijing Chaoyang Hospital affliated to Capital Medical University,Shanxi Aier Eye Hospital,Zhengzhou Second Hospital and Affiliated Hospital of Inner Mongolia Minzu Hospital from May 2020 to April 2021.There were 13 males(13 eyes)and 6 females(6 eyes)with an average age of(37.3±22.0)years-old(6 to 79 years-old).Patients infected by intraocular Candida albicans were defined as the infection group while patients with non-infectious ocular diseases were defined as the control group.All samples were performed Candida albicans immunoglobulin(Ig)G by ELISA and(1,3)-β-D glucan assay by kinetic chromogenic method.Ocular signs and symptoms of the patients in the infection group were recorded.The distributions of ocular signs and symptoms of the patients in the infection group were described by cases and percentage.The levels of IgG and(1,3)-β-D glucan was represented by median and the quartile.Results 6 male(6 eyes)and 3 female(3 eyes)were included in the infection group.The age of patients ranged from 6 to 76 years-old with the average age of(37.5±17.7)years-old.7 male(7 eyes)and 3 female(3 eyes)were included in the control group.The age of patients ranged from 18 to 79 years-old with the average age of(37.2±23.6)years-old.In the infection group,there were 8 cases(8 eyes)diagnosed as endogenous endophthalmitis,accouting for 88.9%(8/9)and 1 case(1 eye)diagnosed as exogenous endophthalmitis,accouting for 11.1%(1/9).The monocular intraocular fluid of patients in the infection group were collected from anterior chamber fluid of 2 cases(2 eyes)and vitreous fluid of 7 cases(7 eyes),accouting for 22.2%(2/9)and 77.8%(7/9);the monocular intraocular fluid of patients in the control group were collected from anterior chamber fluid of 10 cases(10 eyes)and non-vitreous fluid,accouting for 100.0%(10/10)and 0.All patients in the infection group visited the ophthalmologists for the acute loss of vision.Among them,there were 2 patients with metamorphopsia,4 patients with sensation of floaters.The visual acuity of patients ranged from light perception to 0.5.The ocular symptoms included ciliary congestion,keratic precipitates,aqueous flare,hypopyon,caligo pupillae,pigment precipitation on the lens surface,vitreous opacity and preretinal or white lesion with marked subretinal fibrosis.The median and the quartile value of the fungal G assay in the infection group and the control group were 28.9(19.8,55.3)pg/ml and 10(10,10)pg/ml,respectively.The corresponding value of the Candida albicans IgG in the infection group and the control group were 2.8(0.7,89.5)U/ml and 0.6(0.5,0.7)U/ml,respectively.The sensitivity and the specificity of the diagnosis for the fungal G assay in patients infected by intraocular Candida albicans were 88.9%and 90%,respectively.The sensitivity and the specificity of the diagnosis for the Candida albicans IgG in patients infected by intraocular Candida albicans were 66.7%and 100%,respectively.Conclusions Both Candida albicans IgG antibody detection by ELISA and(1,3)-β-D glucan assay by kinetic chromogenic method were valuable in the diagnosis of patients infected by intraocular Candida albicans.