血清半乳甘露聚糖抗原检测在血液病患者侵袭性曲霉菌病诊断中的应用价值  

The retrospective study of serum aspergillus galactomannan （GM） antigen assay in invasive asper-gillosis on hematological diseases

作　　者：王彦艳[1] 萧晨璐[2] 李军民[1] 赵维莅[1] 糜坚青[1] 胡炯[1] 倪语星[2] 沈志祥[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院血液科,200025 [2]上海交通大学医学院附属瑞金医院临床微生物,200025

出　　处：《中华血液学杂志》2013年第6期498-501,共4页Chinese Journal of Hematology

摘　　要：目的探讨血清半乳甘露聚糖（GM）抗原检测（GM试验）在血液病患者侵袭性曲霉菌病（IA）诊断中的应用价值。方法选取2008年1月至2011年12月上海瑞金医院住院的连续2次及以上血常规检查中性粒细胞绝对值〈0．5×10^9／L的血液病患者825例，其中伴发热247例。按《血液病／恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则（第三次修订）》将患者分为确诊IA组、临床诊断＋拟诊IA组及非IA组。采用ELISA法检测患者血清GM抗原浓度，研究GM值介于0．5—1．5的敏感性和特异度。结果GM值单次≥1．0时，其敏感性为66％，特异度为80％；GM值连续2次≥1．0时，其敏感性为73％，特异度为93％。69例患者确诊为IA，感染率为8．36％。结论连续2次血清GM值≥1．0对于抗曲霉菌治疗具有更大参考价值。Objective To explore the relationship between the optical density index of serum asper- gillus galactomannan （GM） assay and invasive aspergillosis （IA）. Methods From Jan 2008 to Dec 2011, 825 hematological diseases patients with neutrophil count 〈 0.5×10^9/L by continuous blood count tests were admitted into our hospital. The optical density index of GM assay was t〉0.5 at least once. Of 825 patients, 247 cases were manifested as fever during hospitalization. The optical density index of GM antigen was detec- ted by enzyme-linked immunosorbent assay, and the sensitivity and specificity of optical density ranged in 0.5 - 1.5. Results In this study, the sensitivity and specificity of GM assay with continuous twice samples （ 73% and 93 % , respectively） were higher than single sample （66% and 80% , respectively） when optical density index ≥1.0. 69 cases were diagnosed as proven IA with the incidence rate of 8.36%. Conclusion The cut-off level for serum GM antigen assay should be decided as optical density index in two continuous samples of ≥1.0.

关 键 词：曲霉菌病 侵袭性真菌感染 半乳甘露聚糖 酶联免疫吸附测定 诊断 

分 类 号：R51[医药卫生—内科学] R44[医药卫生—临床医学]