1,3-β-D-葡聚糖和抗白念珠菌芽管抗体检测对侵袭性念珠菌病诊断的临床价值

目的探讨1,3-β-D-葡聚糖(BG)和抗白念珠菌芽管抗体(CAGTA)对侵袭性念珠菌病(IC)的诊断和治疗监测的临床价值。方法收集IC患者26例、念珠菌定植者100例。动态监测患者血浆BG和血清抗CAGTA含量,分析2项指标单用和联合应用诊断IC的敏感性、特异性、阳性预测值及阴性预测值,分析其与抗真菌治疗疗效间的关系。结果单用BG和抗CAGTA诊断IC的敏感性、特异性、阳性预测值、阴性预测值分别为61.5%、90.0%、61.5%、90.0%和57.7%、83.0%、46.9%、88.3%;BG和抗CAGTA联合检测诊断IC的特异性和阳性预测值均达100.0%,明显高于单项检测。抗真菌治疗有效组随着抗真菌治疗时间的延长,BG和抗CAGTA含量逐渐下降;治疗无效组BG和抗CAGTA含量呈持续上升趋势。结论联合监测BG和抗CAGTA不仅能提高IC诊断的特异性和阳性预测值,而且对IC的早期诊断和治疗监测具有潜在应用价值。

Clinical significance of 1,3-beta-D-glucan and anti-Candida albicans germ tube antibody for the diagnosis of invasive candidiasis

Objective To investigate the clinical significance to diagnose and monitor invasive candidiasis（ IC）using 1,3-beta-D-glucan（ BG） and anti-Candida albicans germ tube antibody（ CAGTA）. Methods The clinical specimens were collected from 26 patients infected IC and 100 patients colonized Candida. BG and CAGTA were detected and monitored dynamically. Sensitivity,specificity,positive and negative predictive values of the detection of BG or CAGTA and the combination detection of BG and CAGTA were analyzed. The relationship between the 2 markers and antifungal therapy was analyzed. Results The sensitivities,specificities,positive and negative predictive values of BG and CAGTA detections were 61. 5%,90. 0%,61. 5%,90. 0% and 57. 7%,83. 0%,46. 9%,88. 3%,respectively.As the combination detection of BG and CAGTA was performed,the specificity and positive predictive value,each up to100. 0%,were significantly higher than those of individual detections. The BG and CAGTA values in the effective group receiving antifungal therapy showed a gradual decline. The BG and CAGTA values varied with a upward trend in the ineffective group. Conclusions The combination detection of BG and CAGTA can improve specificity and positive predictive value for the diagnosis of IC,and it is very useful for the early diagnosis and therapeutic monitoring of IC.