隐球菌荚膜抗原胶体金免疫层析法在非HIV患者隐球菌脑膜炎诊断中的价值

目的探讨隐球菌荚膜抗原胶体金免疫层析法在非HIV患者隐球菌脑膜炎中的诊断价值。方法回顾性分析2013-2018年复旦大学附属华山医院3627例疑似中枢神经系统感染的住院患者的临床资料,收集符合隐球菌脑膜炎初诊的患者214例,分析各检验结果对隐球菌脑膜炎的诊断价值。结果隐球菌脑膜炎患者多数表现为脑脊液糖和氯化物水平显著下降,蛋白含量增高,白细胞增多且以单核细胞为主,脑脊液真菌镜检和培养的阳性率分别为75.23%和78.04%,脑脊液隐球菌胶体金免疫层析法检测阳性率高达100%。隐球菌脑膜炎患者随治疗时间的推移,脑脊液和血的隐球菌荚膜抗原滴度逐渐下降。结论胶体金免疫层析法适用于非HIV患者隐球菌脑膜炎的快速诊断,灵敏度高、特异性强,对隐球菌肺炎的患者能提前筛查是否有中枢神经系统感染,对荚膜抗原的动态监测有助于隐球菌病治疗疗效的观察。

The value of cryptococcal capsular antigen lateral flow immunoassay for diagnosis of cryptococcal meningitis in non-HIV patients

Objective To explore the diagnostic value of colloidal gold lateral flow immunoassay(LFA)for detection of cryptococcal capsular antigen in non-HIV patients with cryptococcal meningitis.Methods A total of 3627 inpatients with suspected central nervous system infection in Huashan Hospital,Fudan University from 2013 to 2018 were reviewed retrospectively.The clinical data were collected from 214 patients with initial diagnosis of cryptococcal meningitis.The laboratory test results were reviewed and analyzed to examine the value of LFA for diagnosis of cryptococcal meningitis.Results The cerebrospinal fluid(CSF)showed significant decrease in sugar and chloride,increased protein content and leukocytosis,predominantly monocytes in most of the patients with cryptococcal meningitis.CSF smear,CSF culture of Cryptococcus and LFA for cryptococcal capsular polysaccharide antigen showed positive result in 75.23%,78.04%and 100%of the patients with cryptococcal meningitis,respectively.The titer of cryptococcal capsular antigen decreased gradually with treatment in both CSF and blood.Conclusions LFA is highly sensitive and specific for rapid diagnosis of cryptococcal meningitis in non-HIV patients.LFA can be used to screen the patients with cryptococcal pneumonia for central nervous system infection.LFA is also useful in evaluating the therapeutic efficacy of cryptococcosis by dynamic monitoring of capsular antigen.