GM抗原检测对血液病患者侵袭性曲霉病的诊断价值  

Diagnostic Value of GM Test of Invasive Aspergillosis in Patients with Hematologic Disease

作　　者：刘亚迪[1] 朱骏[1] 杨一宁[1] 卫菊[1] 魏道林[1] 高彦荣[1] 万理萍[1] 王椿[1] 

机构地区：[1]上海交通大学附属上海市第一人民医院,上海200080

出　　处：《现代生物医学进展》2014年第32期6315-6320,共6页Progress in Modern Biomedicine

摘　　要：目的:探讨血清半乳甘露聚糖(GM)抗原检测对于血液病患者侵袭性曲霉病(invasive aspergillosis,IA)的早期诊断和疗效评价的临床意义。方法:选取137例具有侵袭性真菌病IFD高危因素患者的468份血清标本,进行GM试验,检测抗真菌治疗前后GM抗原水平的变化,同时收集患者的临床资料,进行统计学分析,并评价GM检测对于血液病患者IA的诊断价值。结果:以GM检测单次I≥1.0作为阳性界值时,本试验的敏感性、特异性、阳性预测值和阴性预测值分别为90.91%,95.65%95.24%和91.67%,与试剂盒提供的血清GM试验结果的单次I≥1.5的阳性界值相比敏感性明显提高,而特异性无明显降低,因此能够有效区分临床诊断和拟诊两个IA级别。在其他实验室检测和影像学检查的基础上加入GM试验后,IA临床诊断组的人数明显增加。诊断级别与I值总体均数的分布具有相关性,回顾性确诊IA组、回顾性可疑IA组、回顾性排除IA组的I值呈现明显的由高到低的群落分布,且三个诊断级别的I值分布范围的差异有统计学意义。根据阳性界值标准I≥1.0,GM试验阳性早于痰培养阳性平均7.73±8.71 d,也早于CT影像学证据平均6.89±8.02 d。基于GM值阳性时的抢先抗曲霉治疗组的有效率明显提高(P=0.039)。结论:血清GM抗原检测是早期诊断IA的一种有效方法,将单次I≥1.0作为阳性界值具有较好的敏感性和特异性,在阳性检出率和阳性检出时间方面较主要影像学表现和微生物学证据具有一定优势。在高危血液病伴粒细胞缺乏患者中根据GM试验阳性进行抢先抗曲霉治疗,可提高治疗有效率,监测血清GM浓度的动态变化具有评价疗效的重要价值。该研究成果对临床侵袭性曲霉病的诊断和治疗具有一定指导意义。Objective： Study of the clinical significance of early diagnosis and therapeutic effect evaluation with detection of serum galactomannan （GM） antigen for hematologic disease patients with invasive aspergillosis （invasive aspergillosis, IA）. Methods： 137 cases of patients with IFD disease risk factors of invasive fungal and with 468 serum samples of GM test were chosen to detect the change of GM antigen levels after antifungal treatment, to collect the clinical data and the statistical analysis of the patients, and to evaluate the diagnostic value of GM test for invasive aspergillosis in patients with hematologic disease. Results： We used the detection of GM single ≥ 1 as a positive value, and sensitivity, specificity, positive predictive value and the negative predictive value was 90.91%, 95.65, 95.24% and 91.67% respectively. Compared with the serum GM test results provided with the kit of single ≥ 1.5 positive threshold sensitivity increased significantly with no significant decrease, but the specificity. Therefore, it could effectively distinguish between clinical diagnosis and two suspected IA levels. The GM test is added to the basic examination in other laboratory tests and imaging on clinical diagnosis. The number oflA group increased significantly. Diagnostic level and I value has a correlation between the distribution of population mean. The I value is distributed obviously from high to low level of the community with retrospective diagnosis oflA group, retrospective of suspected IA patients and retrospectively excluded IA group. The I values distribution range had significant differences between the three diagnostic levels. According to the positive critical value of standard 12 1, GM test of positive appeared earlier than in sputum culture of positive for an average of 7.73 ±8.71 d and also earlier than in CT imaging evidence for an average of 6.89 ± 8.02d. The value of GM positive when the preemptive antifungal therapy group improved efficiency based on （P=0.039）. Conclusion：

关 键 词：半乳甘露聚糖 血液病 侵袭性真菌病 侵袭性曲霉病 

分 类 号：S852.32[农业科学—基础兽医学]