中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2011年
1期
43-46
,共4页
侵袭性真菌感染%半乳甘露聚糖抗原%(1→3)-β-D葡聚糖抗原
侵襲性真菌感染%半乳甘露聚糖抗原%(1→3)-β-D葡聚糖抗原
침습성진균감염%반유감로취당항원%(1→3)-β-D포취당항원
Invasive fungal infections%Antigen galactomannan%Antigens( 1,3)-β-D-glucan
目的 评价半乳甘露聚糖(GM)抗原和(1→3)-β-D葡聚糖(BG)抗原检测对恶性血液病患者侵袭性真菌感染(IFI)的诊断价值以及两种方法在监测抗真菌治疗效果中的作用.方法 51例恶性血液病患者当体温超过38 ℃,持续48 h以上,经广谱抗生素治疗无效,或起初有效但体温下降后再次升高时被纳入本研究.第1周采集患者静脉血2次,以后每周采血1次,至少监测4周.分别采用ELISA法和比色法检测患者血清GM和BG值.GM实验阳性定义为连续两次不同时点检测GM值＞0.5或单次＞0.8,G实验阳性定义为BG值＞80 pg/ml.患者分为确诊、临床诊断、拟诊及非真菌感染四组,21名正常志愿者作为对照.结果 51例患者共收集240份血清标本.其中确诊IFI2例,临床诊断26例,拟诊17例,非真菌感染6例.以确诊及临床诊断为真阳性组,以非真菌感染为真阴性组.GM实验在真阳性组28例中21例阳性,真阴性组6例中1例阳性,敏感性75%,特异性83.3%,阳性预测值95.5%,阴性预测值41.7%;G实验在真阳性组28例中全部阳性,真阴性组6例中4例阳性,敏感性100%,特异性33.3%,阳性预测值87.5%,阴性预测值100%.G实验的敏感性高于GM实验,差异有统计学意义(P=0.015);但特异性差异无统计学意义(P=0.242).GM实验阳性的21例患者中抗真菌治疗有效19例,GM值渐转阴性,2例无效的患者GM值持续阳性,有效组GM平均值两周后明显低于无效组,差异有统计学意义(P＜0.05);G实验阳性的患者中治疗有效者BG值逐渐下降,但未转阴;治疗无效组BG值变化无规律,总体呈上升趋势,但各时间点BG值监测对疗效无明显判断意义.结论 血清GM和BG抗原检测可以为早期诊断IFI提供有力证据,联合检测BG和GM两种抗原,可提高对曲霉菌诊断的特异性,减少假阳性.治疗中监测GM和BG值的动态变化,GM实验用于评价疗效的价值优于G实验.
目的 評價半乳甘露聚糖(GM)抗原和(1→3)-β-D葡聚糖(BG)抗原檢測對噁性血液病患者侵襲性真菌感染(IFI)的診斷價值以及兩種方法在鑑測抗真菌治療效果中的作用.方法 51例噁性血液病患者噹體溫超過38 ℃,持續48 h以上,經廣譜抗生素治療無效,或起初有效但體溫下降後再次升高時被納入本研究.第1週採集患者靜脈血2次,以後每週採血1次,至少鑑測4週.分彆採用ELISA法和比色法檢測患者血清GM和BG值.GM實驗暘性定義為連續兩次不同時點檢測GM值＞0.5或單次＞0.8,G實驗暘性定義為BG值＞80 pg/ml.患者分為確診、臨床診斷、擬診及非真菌感染四組,21名正常誌願者作為對照.結果 51例患者共收集240份血清標本.其中確診IFI2例,臨床診斷26例,擬診17例,非真菌感染6例.以確診及臨床診斷為真暘性組,以非真菌感染為真陰性組.GM實驗在真暘性組28例中21例暘性,真陰性組6例中1例暘性,敏感性75%,特異性83.3%,暘性預測值95.5%,陰性預測值41.7%;G實驗在真暘性組28例中全部暘性,真陰性組6例中4例暘性,敏感性100%,特異性33.3%,暘性預測值87.5%,陰性預測值100%.G實驗的敏感性高于GM實驗,差異有統計學意義(P=0.015);但特異性差異無統計學意義(P=0.242).GM實驗暘性的21例患者中抗真菌治療有效19例,GM值漸轉陰性,2例無效的患者GM值持續暘性,有效組GM平均值兩週後明顯低于無效組,差異有統計學意義(P＜0.05);G實驗暘性的患者中治療有效者BG值逐漸下降,但未轉陰;治療無效組BG值變化無規律,總體呈上升趨勢,但各時間點BG值鑑測對療效無明顯判斷意義.結論 血清GM和BG抗原檢測可以為早期診斷IFI提供有力證據,聯閤檢測BG和GM兩種抗原,可提高對麯黴菌診斷的特異性,減少假暘性.治療中鑑測GM和BG值的動態變化,GM實驗用于評價療效的價值優于G實驗.
목적 평개반유감로취당(GM)항원화(1→3)-β-D포취당(BG)항원검측대악성혈액병환자침습성진균감염(IFI)적진단개치이급량충방법재감측항진균치료효과중적작용.방법 51례악성혈액병환자당체온초과38 ℃,지속48 h이상,경엄보항생소치료무효,혹기초유효단체온하강후재차승고시피납입본연구.제1주채집환자정맥혈2차,이후매주채혈1차,지소감측4주.분별채용ELISA법화비색법검측환자혈청GM화BG치.GM실험양성정의위련속량차불동시점검측GM치＞0.5혹단차＞0.8,G실험양성정의위BG치＞80 pg/ml.환자분위학진、림상진단、의진급비진균감염사조,21명정상지원자작위대조.결과 51례환자공수집240빈혈청표본.기중학진IFI2례,림상진단26례,의진17례,비진균감염6례.이학진급림상진단위진양성조,이비진균감염위진음성조.GM실험재진양성조28례중21례양성,진음성조6례중1례양성,민감성75%,특이성83.3%,양성예측치95.5%,음성예측치41.7%;G실험재진양성조28례중전부양성,진음성조6례중4례양성,민감성100%,특이성33.3%,양성예측치87.5%,음성예측치100%.G실험적민감성고우GM실험,차이유통계학의의(P=0.015);단특이성차이무통계학의의(P=0.242).GM실험양성적21례환자중항진균치료유효19례,GM치점전음성,2례무효적환자GM치지속양성,유효조GM평균치량주후명현저우무효조,차이유통계학의의(P＜0.05);G실험양성적환자중치료유효자BG치축점하강,단미전음;치료무효조BG치변화무규률,총체정상승추세,단각시간점BG치감측대료효무명현판단의의.결론 혈청GM화BG항원검측가이위조기진단IFI제공유력증거,연합검측BG화GM량충항원,가제고대곡매균진단적특이성,감소가양성.치료중감측GM화BG치적동태변화,GM실험용우평개료효적개치우우G실험.
Objective To evaluate the diagnostic value of serum galactomannan antigen (GM)and (1→3)-β-D-glucan antigen(BG) assay in invasive fungal infections( IFI ) in the patients with hematologic malignancies and the role in monitoring therapeutic response. Methods Fifty one patients with hematological malignancies met the criteria for inclusion: ①body temperature above 38 ℃ for 48 hours, ②failure to respond to broad-spectrum antibiotic treatment, or ③temperature rose again after the responded drop. Blood samples were collected twice at the first week, then once a week in at least four weeks. The double antibody sandwich enzyme-linked immunosorbent assay( EL1SA )and colorimetric assay were used for detecting GM and BG. The positive GM test is defined as two consecutive tests at different time GM value ＞ 0.5 or ＞ 0. 8 and the positive G test is defined as BG value ＞ 80 pg/ml. The patients were assigned into four groups as proven,probable, possible, and non-fungal infection respectively, and 21 normal volunteers were as controls. Results Two hundred and forty serum samples were collected from 51 patients including 2 of proven IFI, 26 probable IFI, 17 possible IFI and 6 non-fungal infection. The true-positive group including the proven and probable groups, and true negative group was the non-fungal infection group. GM tests were positive in 21 of 28 cases in true positive group, and only one of 6 cases in non-fungal infection. The sensitivity, specificity,positive predictive value and negative predictive value were 75%, 83.3%, 95.5% and 41.7%, respectively. G tests were positive in all 28 cases of the true positive group, and 4 in 6 non-fungal infection cases. The sensitivity, specificity, positive predictive value and negative predictive value were 100%, 33.3%, 87.5% and 100%, respectively. G test is more sensitive than GM test ( P = 0.015 ), but there was no significant difference in specificity of the two tests (P =0.242). In 19 of 21 patients with GM test positive, anti-fungal treatment was effective, and GM value gradually decreased to negative, two invalid patients were persistent with GM test positive. After two weeks treatment, the average GM value was significantly lower in the effective group than in the ineffective group (P ＜ 0.05 ). BG values in the responded patients showed a gradual decline similar to that of GM values, but not to negative. The changes of BG value in ineffective group varied with a trend upward. The changes in BG value had no relation with treatment effectiveness. Conclusions Serum GM and BG antigens detection provides strong evidence for early diagnosis of IFI. Combination of GM and G tests can improve the diagnostic specificity and reduce the false positive GM test seems superior to G test for monitoring GM and BG values during treatment.
