不同免疫状态侵袭性肺曲霉菌病患者治疗前后GM和BG水平变化  

Level changes of GM and BG in patients with IPA before and after treatment in different immune states

作　　者：黄宛虹 磨立达 罗晓璐 林英辉[1] 刘泽端 陈松林[1] HUANG Wanhong;MO Lida;LUO Xiaolu;LIN Yinghui;LIU Zeduan;CHEN Songlin(Department of Clinical Laboratory,the First Affiliated Hospital of Guangxi University of Chinese Medicine,Nanning 530023,Guangxi,China;Nanning Fourth People's Hospital,Guangxi AIDS Clinical Treatment Center(Nanning),Guangxi Medical University Affiliated Nanning Infectious Disease Hospital Laboratory,Nanning 530023,Guangxi,China)

机构地区：[1]广西中医药大学第一附属医院检验教研室,广西南宁530023 [2]南宁市第四人民医院广西艾滋病临床治疗中心(南宁)广西医科大学附属南宁市传染病医院检验科,广西南宁530023

出　　处：《检验医学》2022年第5期443-446,共4页Laboratory Medicine

基　　金：南宁市科学研究与技术开发计划项目(20183039-5);2018南宁市人才小高地专项资金资助项目(2018014);南宁市科学研究与技术开发计划项目(20193008-2)。

摘　　要：目的动态分析侵袭性肺曲霉菌病(IPA)患者治疗前后半乳甘露聚糖(GM)和(1,3)-β-D-葡聚糖(BG)水平变化。方法选取确诊或临床诊断的IPA患者63例,分别于治疗前、治疗1个月、治疗3个月进行外周血GM、BG和淋巴细胞亚群检测。根据是否感染人类免疫缺陷病毒(HIV)分为HIV组(40例)和非HIV组(23例);根据不同CD4^(+)T细胞水平分为A组(CD4^(+)T细胞<200个/μL)、B组(CD4^(+)T细胞为200~500个/μL)和C组(CD4^(+)T细胞>500个/μL)。比较各组BG、GM、CD3^(+)T细胞、CD4^(+)T细胞、CD8^(+)T细胞、CD4/CD8比值差异。结果63例IPA患者治疗3个月GM、BG均低于治疗前、治疗1个月(P<0.05)。HIV组治疗3个月GM、BG均低于治疗前(P<0.05),非HIV组治疗3个月GM低于治疗前(P<0.05)。不同CD4^(+)T细胞水平组中,A组、B组治疗3个月GM水平与治疗前、治疗1个月比较,差异均有统计学意义(P<0.05);A组治疗3个月与治疗前比较,BG差异有统计学意义(P<0.05);C组治疗前、治疗1个月GM低于B组同一治疗期(P<0.05)。结论IPA患者抗真菌治疗后,GM和BG 2项指标联合检测在IPA的诊断及疗效监测中有一定的临床意义。Objective To analyze dynamically the changes of blood galactomannan(GM)and(1,3)-D-glucan(BG)levels in patients with invasive pulmonary aspergillosis(IPA)before and after treatment.Methods A total of 63 IPA patients with confirmed or clinical diagnosis were enrolled,and their peripheral blood GM and BG determinations and lymphocyte subset determinations were performed before treatment,1 month after treatment and 3 months after treatment.According to whether infected human immunodeficiency virus(HIV)(40 cases of HIV group and 23 cases of non-HIV group)or not and different CD4^(+)T cell levels(CD4^(+)T cell count<200 cells/μL in Group A,CD4^(+)T cell count 200-500 cells/μL in Group B,CD4^(+)T cell count>500 cells/μL in Group C).The difference of BG,GM,CD3^(+),CD4^(+)and CD8^(+)T cells,CD4/CD8 was evaluated.Results GM and BG levels of 63 patients with IPA in 3 months after treatment were lower than those before treatment and in 1 month after trearment(P<0.05).In HIV group,GM and BG levels were lower in 3 months after treatment than before treatment(P<0.05),whereas in non-HIV group,GM levels were lower in 3 months after treatment than before treatment(P<0.05).According to the classification of CD4^(+)T cells,the GM levels in Group A and Group B were lower than those before treatment and in 1 month after treatment and in 1 month after treatment(P<0.05),and BG in Group A was lower in 3 months after treatment than before treatment(P<0.05).The level of GM in Group C was lower than that in Group B before treatment and in 1 month after treatment(P<0.05).Conclusions The combined determination of GM and BG plays a role for the diagnosis and antifungal treatment of IPA patients.

关 键 词：半乳甘露聚糖 (1 3)-β-D-葡聚糖 侵袭性肺曲霉菌病 免疫 治疗 

分 类 号：R446.1[医药卫生—诊断学]