摘要
目的:评价1,3-β-D葡聚糖(BG)和甘露聚糖(Mn)检测及其IgG和IgM抗体联合检测在恶性血液病患者侵袭性念珠菌病诊断中的临床价值。方法:收集2015年10月至2017年2月河南省肿瘤医院血液科收治的64例侵袭性念珠菌病住院患者和45例健康体检者的外周血标本,通过动态显色法和ELISA法对比分析BG、Mn抗原及其IgG和IgM抗体单独检测与联合检测的敏感性、特异性等相关指标,并分析恶性血液病治疗过程中常见的中性粒细胞减少及抗真菌药物预防性使用等干扰因素对检测结果的影响。结果:BG和Mn抗原检测针对侵袭性念珠菌病的敏感性和特异性分别是70.3%、80.0%和56.3%、93.3%。48 h内连续2次BG检测对于侵袭性念珠菌的诊断更为准确,但会出现假阴性结果。念珠菌BG和Mn抗原检测的敏感性均受到中性粒细胞缺乏和抗真菌药物使用的影响。IgG和IgM抗体单独检测的敏感性较低(29.7%和39.1%),但抗体检测不受上述2种干扰因素的影响,可以纠正抗原检测的低敏感性。联合检测的AUC为0.830,优于任何单一指标的AUC。结论:BG与Mn抗原、抗体的联合检测可以避免恶性血液病患者治疗过程中常见的中性粒细胞缺乏和抗真菌药物预防性使用等干扰因素的影响,更加敏感、准确地检测侵袭性念珠菌感染。
Aim： To evaluate the value of detecting invasive candida infection using 1,3-β-D glucan（ BG）,mannan（ Mn）,anti-Mn IgG and IgM antibodies（ Mn-IgG and Mn-IgM） in hematologic malignancies patients. Methods： Peripheral blood samples were collected from 64 patients with hematologic malignancies in the department of hematology and 45 objects in health examination from October 2015 to February 2017. Using kinetic chromogenic method and ELISA method,properties including sensitivity,specificity and so on of all the above indicators were comparative analyzed,and the impact of interference factors including neutropenia and empirical antifungal agent was evaluated in invasive candidiasis. Results：The sensitivity and specificity of BG and Mn test were 70. 3%,80. 0% and 56. 3%,93. 3%,respectively. The continued BG test within 48 h was more specific than other indicators,but there also existed false negative result. Sensitivities of BG and Mn were both affected by neutropenia and antifungal agent. The sensitivities of Mn-IgG and Mn-IgM were lower（ 29. 7% and 39. 1%）. However,antibody detection was not affected by the above two interference factors,thus they could make up for the sensitivities of BG and Mn. AUC of the combined detection（ 0. 830） was higher than the AUC of any single indicator. Conclusion： Combined detection of BG,Mn and anti-Mn antibodies could overcome the interference factors such as neutropenia and antifungal agent,is a more sensitive and specific test in diagnosis of invasive candidiasis.
出处
《郑州大学学报（医学版）》
CAS
北大核心
2018年第1期84-88,共5页
Journal of Zhengzhou University(Medical Sciences)
基金
河南省医学科技攻关计划基金资助项目(201602286)
