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目的:探讨血清半乳甘露聚糖(GM)抗原检测对于血液肿瘤患者侵袭性曲霉病(invasive aspergillo-sis,IA)的早期诊断和疗效评判的临床意义。方法:选取127例血液肿瘤并发中性粒细胞减少伴发热、广谱抗生素治疗无效的患者治疗前后的402份血清标本。采用ELISA法进行血清GM浓度测定,同时收集患者的临床资料。评价GM测定对于血液肿瘤患者IA的诊断价值和抗真菌治疗前后GM浓度变化的意义,并进行统计学分析。结果:拟将本观察组血液肿瘤患者并发IA的血清GM检测结果的单次I≥0.7,或连续2次I≥0.5做为阳性界值时,本试验的敏感性、特异性、阳性预测值和阴性预测值分别为92.3%、82.4%、57.1%和97.7%,与试剂盒提供的血清GM试验结果的I≥1.5的阳性界值相比灵敏度提高,而特异性无明显降低,因此能够有效区分临床诊断和拟诊两个IA级别。在其他实验室检测和影像学结果基础上加入GM试验后,临床诊断病例组的人数明显增加。根据我们确定的阳性界值标准,GM实验阳性早于痰培养或涂片平均(6.1±4.5)d(1～11d);也早于CT影像学证据平均(7.2±5.5)d(1～15d)。抗真菌治疗有效患者的GM水平随着治疗呈波动性下降,无效患者GM水平无变化。GM浓度与本观察组患者疾病的治疗及预后具有相关性。结论:血清GM抗原检测是早期诊断IA的一种有效方法。将单次I≥0.7或连续2次I≥0.5作为阳性界值比单用一种界值敏感性提高,特异性理想。在高危血液肿瘤伴粒细胞缺乏患者中以GM实验阳性为起点抢先抗曲霉菌治疗,可降低IA病死率,监测血清GM浓度的动态变化具有评判疗效的重要价值。
Objective: To investigate the clinical significance of detection of serum GM galactomannan (GM) antigen in the early diagnosis and evaluation of invasive aspergillosis-sis (IA) in hematological malignancies. Methods: A total of 402 serum samples from 127 patients with hematological neoplasm complicated with neutropenia and fever who were treated with broad-spectrum antibiotics before and after treatment were enrolled. Serum GM concentration was measured by ELISA, and the clinical data of patients were also collected. To evaluate the diagnostic value of GM determination in patients with hematological malignancies and the significance of GM concentrations before and after antifungal therapy, and to make statistical analysis. Results: The sensitivity, specificity and positive predictive value of this test in this group of patients with hematological malignancies who were diagnosed with IA when the serum GM test results were single I≥0.7 or two times I≥0.5 as positive cutoffs And negative predictive values of 92.3%, 82.4%, 57.1% and 97.7%, respectively, were higher than the positive cutoff values of I≥1.5 in the serum GM test provided by the kit, but the specificity was not significantly reduced and therefore effective Distinguish between clinical diagnosis and diagnosis of two IA levels. The number of patients in the clinically diagnosed cases increased significantly after GM testing was added to other laboratory tests and imaging findings. According to our positive cut-off criteria, the GM test was earlier than the average sputum culture or smear (6.1 ± 4.5) days (1 to 11 days) and earlier than the mean (7.2 ± 5.5) days (1 to 15 days) of CT imaging ). The anti-fungal treatment of patients with GM levels decreased with the treatment of volatility, GM level in patients with no change. The concentration of GM was related to the treatment and prognosis of patients in this observation group. Conclusion: The detection of serum GM antigen is an effective method for the early diagnosis of IA. A single I ≥ 0.7 or two consecutive I ≥ 0.5 as a positive cut-off than a single cut-off sensitivity increased, the specificity of the ideal. The high prevalence of hematologic malignancies with agranulocytosis in patients with GM positive test as a preemptive anti-Aspergillus treatment can reduce the IA mortality, monitoring the dynamic changes of serum GM concentration has important value in the evaluation of the curative effect.