念珠菌血症时甘露聚糖抗原及其IgG抗体检测诊断价值的临床研究

目的评价念珠菌甘露聚糖抗原（M抗原）及甘露聚糖IgG抗体（M-IgG抗体）检测诊断念珠菌血症的价值。方法收集2013年5月～2014年1月我院住院患者及健康体检人群共107例，包括念珠菌血症组（念珠菌血培养阳性患者）13例、危险因素组（临床诊断侵袭性念珠菌病或接受化疗恶性疾病、留置深静脉置管等侵袭性念珠菌病感染高危患者）63例和对照组（健康体检人群）31例。通过ELISA方法检测甘露聚糖抗原及甘露聚糖IgG抗体，比较3组人群检测阳性情况及持续时间，计算两种方法的灵敏度、特异度、阴性预测值、阳性预测值、ROC曲线下面积及Kappa值。结果白念珠菌和光滑念珠菌为念珠菌血症的主要念珠菌病原，均为5例。念珠菌血症的7／14菌株（1例患者合并2种念珠菌感染）来自重症医学科，其次为感染内科（2／14株）。除1例死亡病例外，余12例患者进行了M抗原和M—IgG抗体监测。首次M抗原检测中，4例阳性，1例可疑阳性；首次M-IgG抗体检测中，11例阳性，1例可疑阳性。经抗真菌治疗，监测14d，M-IgG抗体持续阳性时间长于M抗原。甘露聚糖抗原在诊断念珠菌血症的敏感度41．7％，特异度98．8％，阴性预测值92．4％，阳性预测值100％。甘露聚糖IgG抗体在诊断念珠菌血症的敏感度91．7％，特异度52．8％，阴性预测值100％，阳性预测值27．5％。M抗原、M抗原并M—IgG抗体作为念珠菌血症时诊断实验的ROC曲线下面积均为0．708（95％CI：0．517—0．900），两者的Kappa值分别为0．520和0．559。结论甘露聚糖抗原在诊断念珠菌血症时的特异度较高，甘露聚糖IgG抗体在诊断念珠菌血症的敏感性较高，两者的联合检测可以适当提高检测的敏感度及特异度，有助于念珠菌血症的诊断。

Diagnostic value of mannan and mannan-IgG antibody in cadidemia.a clinical research

Objective To discuss the diagnostic value of mannan and mannan IgG antibody in candidemia. Method Total 181 serum samples from 107 persons of inpatients and healthy people were collected from May 2013 to January 2014 in our hospital. These people were divided into three groups： candidemia group with Candida blood-culture positivity （13/107）, risk factor group with probable invasive candidiasis, hematologic malignancies or risk factors of invasive candida infection （63/ 107） ,control group of health examination people （31/107）. The mannan and anti-mannan IgG antibody were determined by ELISA,and then compared with each other. The diagnosis value of mannan and anti-mannan IgG anti-body were evaluated through the sensitivity, specificity, positive predictive value, negative predictive value, the area of ROC curve and Kappa score. Result Five isolates of Candida albicans （38.46 %） and 5 isolates of Candida grabrata （38.46 %） were the main pathogens of candidemia. Among all 14 isolates of candidemia,7 stains were from Intensive Care Unit and 2 strains were from Infectious Disease Department. There were 12 patients being performed mannan and anti-mannan-IgG antibody detection, except one. Four patients were tested positive and one was suspicious positive in the first mannan detection. Eleven were tested positive and one was suspicious positive in the first anti-mannan IgG antibody detection. Undergoing anti-fungal therapy,anti-mannan IgG antibody persisted longer positivity than mannan during 14 days supervision. For candidemia, the sensitivity, specificity, positive predictive value and negativity predictive value of mannan and anti-mannan antibody were 41.7%, 98.8%, 92.4%, 100% and 91.7% ,52.8% ,100% ,27.5% respectively. The areas under the Receive Operating Characteristic curve of mannanand mannan and antimannan antibody were both 0. 708 （95%CI： 0. 517-0. 900）. The Kappa scores were respectively 0. 520 and 0. 559. Conclusion Candida albicans and Candida grabrata were the main pathogens of