血清半乳甘露聚糖检测对血液病患者侵袭性曲霉菌感染早期诊断的价值

 目的　评价血清半乳甘露聚糖（GM）检测对血液病患者侵袭性曲霉菌（IA）感染早期诊断的价值。方法　前瞻性采用酶联免疫吸附试验（ELISA）每周2次测定患者的GM水平，并计算该诊断试验的各项评价指标。结果　共有来自92例患者的113例次感染进入研究，检测血清标本472份，以确诊IA感染和临床诊断IA感染为真阳性组，排除IA感染为真阴性组，0.7为阈值，连续2次GM结果阳性为真阳性，该诊断试验的敏感度为83.3 %，特异度为91.1 %，阳性预测值为78.9 %，阴性预测值为93.1 %。GM阳性结果较痰培养阳性时间提前4 d（1～7 d），比影像学改变提早7 d（1～14 d），较抗真菌治疗提前6 d（1～15 d）。结论　通过ELISA方法进行血清GM检测可以快速、灵敏的为早期诊断IA感染提供有力证据。

Value of circulating galactomannan screening for early diagnosis of invasive aspergillosis in hematological patients

Objective To detect the value of serum galactomannan （GM） for diagnosis of invasive aspergillosis （IA） in hematological patients. Methods We prospectively evaluated the diagnostic value of twice-weekly screening for circulating Aspergillus fumigatus with sanditeh enzyme linked immunosorbent assay. Results On the basis of the analysis of 472 serum samples from 113 episodes of 92 patients, the sensitivity, specificity, positive and negative predictive values of the sandwich ELISA for proven and probable [A cases were 83.3 %, 91.1%, 78.9 % and 93.1%, respectively, when samples with 2 consecutive positive results ≥ 0.7 were used. Furthormore, GM antigenemia was detected before the onset of radiologic signs with a median of 7 days （range, 1-14 days）, before isolation of Aspergillus with a median of 4 days （range, 1-7 days）, and before anti-fungal therapy with a median of 6 days （range, 1-15 days）. Conclusion The sandwich ELISA for GM detection is a reliable method for early diagnosis of IA in patients with haematological diseases.