侵袭性真菌深部感染的早期实验室诊断

目的探讨假丝酵母菌甘露聚糖抗原和假丝酵母菌IgG/IgM抗体、曲霉半乳甘露聚糖抗原和烟曲霉IgG抗体在侵袭性真菌病早期临床诊断中的应用价值。方法收集已确诊侵袭性假丝酵母菌病患者18例,侵袭性烟曲霉病患者6例,单纯细菌感染患者20例,浅部真菌感染患者20例,健康体检者(正常对照组)20例,通过酶联免疫吸附法(ELISA)检测患者血清甘露聚糖和假丝酵母菌IgG/IgM抗体以及曲霉半乳甘露聚糖抗原和烟曲霉IgG抗体浓度,计算各指标的灵敏度、特异度、阳性预测值、阴性预测值和受试者工作特征(ROC)曲线下面积。结果甘露聚糖抗原和假丝酵母菌IgG/IgM抗体联合测定的敏感度为66.7%,特异度为83.3%,阴性预测值为100.0%,阳性预测值为85.7%,ROC曲线下面积为0.992(95%CI:0.974~1.000);半乳甘露聚糖抗原和烟曲霉IgG抗体联合测定的敏感度为66.7%,特异度为95.0%,阴性预测值为98.2%,阳性预测值为100.0%,ROC曲线下面积为0.978(95%CI:0.934~1.000)。结论甘露聚糖抗原和假丝酵母菌IgG/IgM抗体、半乳甘露聚糖抗原和烟曲霉IgG抗体联合检测对深部真菌感染的早期诊断具有重要意义。

Early laboratory diagnosis of invasive fungal infection

Objective To discuss the early clinical diagnostic value of mannan and anti-mannan IgG/IgM antibodies,galactomannan and Aspergillus fumigatus IgG antibodies in invasive fungal disease. Methods Serum specimens were collected from 18 patients with invasive candidiasis,6 patients with invasive aspergillosis,20 patients with bacterial infection,20 patients with superficial fungal infection and 20 healthy subjects(healthy control group).The levels of serum mannan and anti-mannan IgG/IgM antibodies,and galactomannan and aspergillus fumigatus IgG antibodies were determined by using enzyme-linked immunosorbent assay(ELISA).The results were analyzed by calculating the sensitivity,specificity,positive predictive value,negative predictive value and the area under receiver operating characteristic(ROC)curve. Results The sensitivity,specificity,negative predictive value and positive predictive value of combined detection of mannan and anti-mannan IgG/IgM antibodies were 66.7%,83.3%,100.0% and 85.7% respectively,and the area under ROC curve was 0.992(95% CI:0.974-1.000).The sensitivity,specificity,negative predictive value and positive predictive value of combined detection of galactomannan and aspergillus fumigatus IgG antibodies were 66.7%,95.0%,98.2% and 100.0% respectively,and the area under ROC curve was 0.978(95% CI:0.934-1.000). Conclusion Combined detection of mannan and anti-mannan IgG/IgM antibodies and galactomannan and aspergillus fumigatus IgG antibodies have important significance in the early diagnosis of invasive fungal infection.