摘要
目的 分析血清半乳甘露聚糖抗原（galactomannan,GM）检测结果在成人血液病患者侵袭性真菌感染（IFD）抗真菌治疗中的意义。方法 回顾性研究在肺部曲霉感染的高危血液病患者,每周2-3次检测血清GM。按照欧洲癌症/真菌病研究组的研究和治疗组织（EORTC-MS）规定的定义对侵袭性曲霉病（IA）进行分组。结果 82例患者中确诊IA1例,临床诊断IA28例,拟诊的IFD23例,排除IFD30例。以确诊和临床诊断作为阳性病例计算GM检测的灵敏度为79.3%（23/29）,以拟诊和无IFD作为阴性病例计算,试验特异度为83.0%（44/53）,阳性预测值为79.3%（23/29）,阴性预测值为88.0%（44/50）。本组82例患者在中位数为19.7（9-26）d开始采取预防性氟康唑治疗。GM阳性值出现时间比高分辨率计算机断层扫描（HRCT）或胸部X线检查（CXR）提前4-14 d。结论 血液科高危患者血清GM每周检测2-3次,GM试验出现阳性比HRCT和CXR阳性报告提前4-14 d,GM升高与曲霉侵袭量有关。GM结果可作为侵袭性曲霉病高危人群的早期干预治疗参考指标。
Objective To analyze the correlation between dynamic monitoring of serum galactomannan antigen （GM） and antifungal treatment in adult hematologic patients at risk of invasive aspergillosis. Methods A retrospective study was conducted in hematologic patients at high risk of Aspergillus pulmonary infection. Serum GM was monitored 2-3 times per week during the period of high risk for invasive aspergillosis （IA）. High-resolution computed tornography （HRCT） was performed in case of abnormal chest X-ray and/or persistent fever after 5 days of antibiotic treatment. IA was classified as proven or probable in accordance with the definitions proposed by the European Organization for Research and Treatment of Cancer/Mycosis Study Group （EORTC-MS）. Results A total of 82 hematological patients at risk of invasive aspergillosis were included in this analysis. IA was proven in one patient, probable in 28 patients, possible invasive fungal disease （IFD） in 23 patients, and no IFD in the remaining 30 patients. GM test showed sensitivity of 79. 3~ （23/29）, specificity of 83. 0~ （44/53） in detecting IFD. The positive predictive value was 71.9%. The negative predictive value was 88. 0%. The median duration of prophylactic fluconazole therapy was 19. 7 （range 9-26） days for the 82 patients. The onset of positive GM result was 4 14 days earlier than the finding of HRCT or chest X-ray scan. Conclusions Serum GM should be tested 2-3 times per week in adult hematologic patients at risk of invasive aspergillosis. Increased GM value is associated with higher fungal load. Positive GM test may he an indicator for preemptive antifungal therapy in adult hematologic patients at risk of invasive aspergillosis.
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2015年第4期364-367,共4页
Chinese Journal of Infection and Chemotherapy
