血清半乳甘露聚糖试验对侵袭性肺曲霉菌感染的诊断价值  

Significance of Serum Galactomannan Detection in Invasive Pulmonary Aspergillosis Diagnosis

作　　者：李尔然[1] 姜艳霞[2] 王昆[1] 李艳玲[1] 康健[1] 

机构地区：[1]中国医科大学附属第一医院呼吸疾病研究所,沈阳110001 [2]辽宁省人民医院呼吸内科,沈阳110016

出　　处：《中国医科大学学报》2015年第10期865-869,共5页Journal of China Medical University

基　　金：国家自然科学基金(30470766);高等学校博士学科点专项科研基金(20040159011);教育部留学归国启动基金(教外司留[2004]527);辽宁省重点实验室资助项目(2009S105)

摘　　要：目的探讨血清半乳甘露聚糖（GM）试验在侵袭性肺曲霉病（IPA）中的临床诊断价值。方法收集2010年3月至2011年3月期间中国医科大学附属第一医院及周边5所医院住院IPA高危患者共计103例,男60例（58.3%）,女43例（41.7%）,中位年龄51.90岁（18~86岁）。应用双夹心酶联免疫吸附法（ELISA）对疑诊患者的血清GM进行检测。结果所有入选患者中,确定诊断7例（6.8%）,临床诊断19例（18.4%）,拟诊40例（38.8%）,排除IPA感染37例（36%）。以血清GM值单次〉0.5为本次研究的界值,其敏感度、特异度、阳性预测值及阴性预测值分别为85.7%、86.5%、55%及97%,与拟诊组相比,GM检测对确诊组有更好的临床符合度。将入选患者分为粒缺组与非粒缺组时,GM检测的敏感性分别为74%与42%,在非粒缺患者中,GM试验对慢性肺部基础疾病并发IPA的诊断敏感性、特异性、阳性预测值及阴性预测值分别为71.4%、84.4%、66.75%及87.1%。以GM值0.5作为阳性界值,对可疑IPA患者给予抗曲霉菌治疗。与对照组相比,随着诊断级别的提高,拟诊组、临床诊断组及确诊组抗真菌治疗有效率逐渐降低,分别为70%、56%、40%。结论以GM值0.5作为阳性界值对IPA诊断有着良好的敏感性及特异性。GM试验在非粒缺合并慢性肺基础疾病的患者中诊断价值较高。GM试验与影像学检查、体液培养等传统检测方法相比,具有更高的敏感性及特异性,联合诊断能够提高IPA的临床诊断率。Objective To evaluate the value of serum galactomannan（GM）detection for invasive pulmonary aspergillosis（IPA）diagnosis.Methods The suspicious IPA patients were divided into proven,clinical and possible IPA groups. The patients excluded of IPA were recruited as controls. The serum GM concentration was detected by Platelia Aspergillus double-sandwich enzyme linked immunosorbent assay（ELISA）. Results In the 103 patients,there were seven cases diagnosed as proven,nineteen cases diagnosed as clinical and forty cases diagnosed as possible IPA patients. Setting 0.5 as the optimal result for GM detection,the sensitivity,specificity,positive predictive values and negative predictive values of GM were 85.7%,86.5%,55% and 97%,respectively. In non-neutropenia patients combinded with the pulmonary chronic diseases,the sensitivity,specificity,positive predictive values and negative predictive values of GM detection were 71.4%,84.4%,66.75% and 87.1%,respectively. Conclusion Index0.5 for GM test could increase the sensitivity without obvious decreased specificity. GM detection could provide valuable information in patients of non-neutropenia underlying the pulmonary chronic diseases,which had a better sensitivity and specificity versus conventional diagnostic tests.

关 键 词：血清半乳甘露聚糖检测 侵袭性肺曲霉病 

分 类 号：R563.1[医药卫生—呼吸系统]