侵袭性念珠菌病患者抗烯醇化酶抗体水平升降及影响因素  

Changes and influencing factors of levels of antibody against Candida enolase in patients with invasive candidiasis

作　　者：李芳秋[1] 胡毓安[1] 史利宁[1] 廖红[1] 李伟[1] 张国勇[1] 刘倩[1] 商秀娟[1] 

机构地区：[1]南京军区南京总医院解放军临床检验医学研究所,南京210002

出　　处：《临床检验杂志》2014年第11期817-820,共4页Chinese Journal of Clinical Laboratory Science

基　　金：国家自然科学基金(81302536);南京军区医学科技创新重点课题(10Z027);江苏省科技支撑计划-社会发展项目(BE2009673)

摘　　要：目的评估抗念珠菌烯醇化酶（enolase,Eno）抗体（抗Eno）对侵袭性念珠菌病（invasive candidiasis,IC）的诊断价值,分析IC患者体内抗Eno水平变化趋势及影响因素。方法连续收集外科重症监护病房（ICU）IC易感患者从入住ICU当天到转出ICU或死亡的血清样本,3-5 d 1份（共收集血清1 200份,每例患者1-26份不等）。用ELISA法测定抗Eno抗体。结合念珠菌培养结果,观察抗体水平首次升高、下降的时间及影响因素。结果 307例临床显示脓毒症患者中,68例抗Eno阳性,34例念珠菌培养阳性。抗体与念珠菌培养共同阳性者21例,其中半数以上患者的抗Eno水平升高出现在培养结果阳性前;高水平抗Eno在30-60 d下降至临界值以下。47例抗体阳性但培养阴性患者中,预防用抗真菌药22例（46.8%）;13例抗体阴性的确诊病例中,11例使用糖皮质激素。结论抗Eno诊断IC的敏感性高于念珠菌培养,特别是对于预防性用抗真菌药的患者;抗体水平首次升高出现在IC早期,随后下降,使用免疫抑制剂可干扰抗体检出。Objective To evaluate the diagnostic value of anti-Candida enolase antibody（anti-Eno） in invasive candidiasis（IC）, and analyze the changes and influencing factors of levels of anti-Eno antibody in IC patients. Methods The patients admitted into surgical intensive care unit（ICU） were enrolled in this study. Their serum samples were collected on the day of admission into the ICU and once every 3-5 days subsequently until discharge from ICU or death. A total of 1 200 serum samples, with 1 to 26 samples each pa- tient, were collected and determined the level of anti-Eno antibody by ELISA. Combined with the results of Candida culture, the chan- ges and influencing factors of anti-Eno antibody levels were analyzed. Results Of 307 patients with clinical evidence of sepsis, 68 were positive in anti-Eno antibody, 34 positive in Candida culture, and 21 positive in both anti-Eno antibody and Candida culture. In more than 50% of patients, the increased level of anti-Eno antibody was found prior to positive Candida culture. Within 30-60 days, the level of anti-Eno antibody decreased to below the cut-off value. Among 47 patients with positive anti-Eno antibody and negative Candida culture, 22 （46.8%） were prevented with prophylactic anti-fungal agents. Among 13 patients with negative anti-Eno antibod- y, 11 received corticosteroids. Conclusion For the diagnosis of IC, the sensitivity of anti-Eno antibody is superior to Candida cul- ture, especially in the patients with prophylactic anti-fungal agents. The increased level of anti-Eno antibody is found in the early phase of IC, and then decreases sequentia. In addition, immunosuppressant may interfere in the detection of anti-Eno antibody.

关 键 词：侵袭性念珠菌病 念珠菌烯醇化酶 抗体 诊断 

分 类 号：R446.5[医药卫生—诊断学]