CAJ | 학술논문

目的：评价2种基质辅助激光解析电离飞行时间质谱（MALDI-TOF MS）系统（Autoflex MALDI-TOF MS 和 Vitek MALDI-TOF MS）在快速鉴定血培养中分离的白念珠菌以外酵母样真菌的应用。方法收集复旦大学附属中山医院2010年10月至2013年1月住院患者血培养中分离的白念珠菌以外酵母样真菌59株，以真菌内转录间隔区（ITS）测序鉴定结果为金标准，比较 Autoflex MALDI-TOF MS、Vitek MALDI-TOF MS 和 API 20C AUX 3种系统鉴定的准确性。结果59株菌株包含了11种真菌，其中近平滑复合体30株（占50．8％）、热带念珠菌11株（占18．6％）、光滑念珠菌8株（占13．6％）、克柔念珠菌2株（占3．4％）、新生隐球菌2株（占3．4％）、异常威克汉姆酵母2株（占3．4％）、季也蒙念珠菌复合体1株（占1．7％）、葡萄牙念珠菌1株（占1．7％）、阿萨希毛孢子菌1株（占1．7％）和酿酒酵母1株（占1．7％）。3种系统鉴定真菌总的准确性分别为 Autoflex MALDI-TOF MS 93．2％、Vitek MALDI-TOF MS 83．1％和 API 20C AUX 79．7％，2种 MALDI-TOF MS 比较，差异无统计学意义（P ＝0．155）。其中对白念珠菌以外酵母样真菌的鉴定准确性分别为 Autoflex MALDI-TOF MS 100．0％、Vitek MALDI-TOF MS 84．9％和 API 20C AUX 84．9％，2种 MALDI-TOF MS 比较，差异具有统计学意义（P ＝0．006）。对念珠菌属外的少见真菌鉴定准确性分别为 Autoflex MALDI-TOF MS 33．3％、Vitek MALDI-TOF MS 66．6％和 API 20C AUX 33．3％。结论MALDI-TOF MS 系统和目前常规生化鉴定方法相比，具有快速、操作简便、结果准确等优点；对于临床血培养分离真菌的鉴定，Autoflex MALDI-TOF MS 鉴定准确性和 Vitek MALDI-TOF MS 相似，但对常见非白念珠菌的鉴定，Autoflex MALDI-TOF MS 鉴定准确性优于 Vitek MALDI-TOF MS。
목적：평개2충기질보조격광해석전리비행시간질보（MALDI-TOF MS）계통（Autoflex MALDI-TOF MS 화 Vitek MALDI-TOF MS）재쾌속감정혈배양중분리적백념주균이외효모양진균적응용。방법수집복단대학부속중산의원2010년10월지2013년1월주원환자혈배양중분리적백념주균이외효모양진균59주，이진균내전록간격구（ITS）측서감정결과위금표준，비교 Autoflex MALDI-TOF MS、Vitek MALDI-TOF MS 화 API 20C AUX 3충계통감정적준학성。결과59주균주포함료11충진균，기중근평활복합체30주（점50．8％）、열대념주균11주（점18．6％）、광활념주균8주（점13．6％）、극유념주균2주（점3．4％）、신생은구균2주（점3．4％）、이상위극한모효모2주（점3．4％）、계야몽념주균복합체1주（점1．7％）、포도아념주균1주（점1．7％）、아살희모포자균1주（점1．7％）화양주효모1주（점1．7％）。3충계통감정진균총적준학성분별위 Autoflex MALDI-TOF MS 93．2％、Vitek MALDI-TOF MS 83．1％화 API 20C AUX 79．7％，2충 MALDI-TOF MS 비교，차이무통계학의의（P ＝0．155）。기중대백념주균이외효모양진균적감정준학성분별위 Autoflex MALDI-TOF MS 100．0％、Vitek MALDI-TOF MS 84．9％화 API 20C AUX 84．9％，2충 MALDI-TOF MS 비교，차이구유통계학의의（P ＝0．006）。대념주균속외적소견진균감정준학성분별위 Autoflex MALDI-TOF MS 33．3％、Vitek MALDI-TOF MS 66．6％화 API 20C AUX 33．3％。결론MALDI-TOF MS 계통화목전상규생화감정방법상비，구유쾌속、조작간편、결과준학등우점；대우림상혈배양분리진균적감정，Autoflex MALDI-TOF MS 감정준학성화 Vitek MALDI-TOF MS 상사，단대상견비백념주균적감정，Autoflex MALDI-TOF MS 감정준학성우우 Vitek MALDI-TOF MS。
Objective To evaluate the application of 2 matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS),Autoflex MALDI-TOF MS and Vitek MALDI-TOF MS,for the identification of Yeast like fungi outside of Candida albicans isolated from blood culture.Methods A total of 59 isolates were collected from blood culture from October 201 0 to February 201 3 among inpatients in Zhongshan Hospital,Fudan University.The results of fungus internal transcribed spacer (ITS)sequencing were as golden standards.The correct identification rates of Autoflex MALDI-TOF MS,Vitek MALDI-TOF MS and API 20C AUX were analyzed comparatively.Results The 59 isolates included 1 1 types of fungi,namely,Candida parapsilosis complex(30 isolates,50.8%),Candida tropicalis(1 1 isolates,1 8.6%),Candida glabrata (8 isolates,1 3.6%),Candida krusei (2 isolates,3.4%),Wickerhamomy cesanomalus(2 isolates,3.4%),Cryptococcus neoformans(2 isolates,3.4%),Candida iusitaniae(1 isolate,1 .7%), Candida guilliermondii (1 isolate,1 .7%),Trichosporon asahii(1 isolate,1 .7%)and Saccharomyces cerevisiae (1 isolate,1 .7%).The correct identification rates by Autoflex MALDI-TOF MS,Vitek MALDI-TOF MS and API 20C AUX were 93.2%,83.1 % and 79.7%,respectively,and there was no statistical significance between the 2 MALDI-TOF MS systems (P =0.1 55 ).The correct identification rates for yeast like fungi outside of Candida albicans by Autoflex MALDI-TOF MS,Vitek MALDI-TOF MS and API 20C AUX were 1 00.0%,84.9% and 84.9%, respectively,and there was statistical significance between the 2 MALDI-TOF MS systems(P =0.006).The correct identification rates of rarely clinical encountered fungi by Autoflex MALDI-TOF MS,Vitek MALDI-TOF MS and API 20C AUX were 33.3%,66.6% and 33.3%,respectively.Conclusions MALDI-TOF MS system is rapid,simple and accurate compared with current routine biochemical identification methods.The performance of Autoflex MALDI-TOF MS is similar with that of Vitek MALDI-TOF MS for the identification of isolated fungi from blood culture.The performance of Autoflex MALDI-TOF MS is better than that of Vitek MALDI-TOF MS for the identification of yeast like fungi outside of Candida albicans.