CAJ | 학술논문

目的：探讨应用血清半乳甘露聚糖试验(GM)对侵袭性真菌感染(IFI)的诊断价值。方法采集74例具有IFI高危因素患者的178份血清，按GM检测试剂盒说明采用ELISA法检测GM抗原水平。参照IFI诊断标准，以确诊IFI病例为研究组(16例)，排除IFI诊断病例为对照组(29例)，建立四格表进行GM检测灵敏度、特异度、阳性预测值、阴性预测值等判定；53例接受抗真菌治疗患者，按GM值分为阳性组(I≥0.5，21例)和阴性组(I＜0.5，32例)，比较两组抗真菌药治疗效果。结果74例患者中，确诊IFI患者2例中GM阳性1例(50％)，临床诊断IFI患者14例中GM阳性9例(64％)，临床拟诊IFI患者29例中GM阳性10例(34％)，排除IFI患者29例中GM阳性4例(14％)。GM检测试验灵敏度63％、特异度86％、阳性预测值0.71、阴性预测值0.81、诊断符合率78％、Youden指数0.49。阳性组氟康唑治疗有效率明显低于阴性组(x2=4.95，P＜0.05)，非氟康唑治疗有效率明显高于阴性组(x2=4.88，P＜0.05)，阳性组治疗后GM值明显低于治疗前(t =2.13，P＜0.05)。结论GM对IFI的诊断特异度较高，可指导临床筛选有效的抗真菌药物。
목적：탐토응용혈청반유감로취당시험(GM)대침습성진균감염(IFI)적진단개치。방법채집74례구유IFI고위인소환자적178빈혈청，안GM검측시제합설명채용ELISA법검측GM항원수평。삼조IFI진단표준，이학진IFI병례위연구조(16례)，배제IFI진단병례위대조조(29례)，건립사격표진행GM검측령민도、특이도、양성예측치、음성예측치등판정；53례접수항진균치료환자，안GM치분위양성조(I≥0.5，21례)화음성조(I＜0.5，32례)，비교량조항진균약치료효과。결과74례환자중，학진IFI환자2례중GM양성1례(50％)，림상진단IFI환자14례중GM양성9례(64％)，림상의진IFI환자29례중GM양성10례(34％)，배제IFI환자29례중GM양성4례(14％)。GM검측시험령민도63％、특이도86％、양성예측치0.71、음성예측치0.81、진단부합솔78％、Youden지수0.49。양성조불강서치료유효솔명현저우음성조(x2=4.95，P＜0.05)，비불강서치료유효솔명현고우음성조(x2=4.88，P＜0.05)，양성조치료후GM치명현저우치료전(t =2.13，P＜0.05)。결론GM대IFI적진단특이도교고，가지도림상사선유효적항진균약물。
Objective To evaluate the value of serum galactomannan platelia aspergillus kit in the diagnosis and treatment of invasive fungal infection(IFI) patients. Methods A total of 178 serum samples from 74 high risk patients were collected. ELISA assay was used to detect the level of GM antigen. Refer to domestic IFI diagnostic criteria, 16 patients include the proven cases and probable cases were defined as study group, while 29 patients of improbable cases defined as control group. Fourflod table was founded,by which the sensitivity,specificity,positive predictive value, negative predictive value of this GM test were calculated. Meanwhile, a total of 53 patients received antifungal therapy which divided into GM-positive group(21 patients with I≥0. 5) and GM-negative group(32 patients with I ＜0. 5). The therapeutic effect comparison of two groups was made according to curative effect criterion. Results According to the certainty level of IFI diagnosis, 1,9,10 and 4 patients were identified as GM positive in proven, probable,possible and improbable IFI groups respectively. The prevalence of GM in these 4 groups was 50％ ,64％ ,34％ and 14％ ,respectively. The sensitivity and specificity of galactomannan ELISA assay were 63％ ,86％ respectively. The positive and negative predictive values were 71％ and 81％ respectively. The diagnose accordance rate was 78％, the Younden index was 0. 49. The efficacy of fluconazole in GM-positive patients was significant lower than in GMnegative patients( x2 =4. 95 ,P ＜0. 05) ,while The efficacy of non-fluconazole drug was superior to that in GM-negative patients( x2 =4. 88,P ＜ 0. 05). After antifungal therapy, the GM value of GM-positive patients decreased significantly( t =2. 13 ,P ＜0. 05). Conclusion The galactomannan ELISA assay with high specificity, could be helpful in diagnosis and choicing effective anti-fungi drug in clinic.