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目的评价酶联免疫吸附法(ELISA)连续检测血清半乳甘露聚糖(galactomannan,GM)抗原对侵袭性曲霉病(in-vasive aspergillosis,IA)早期诊断和疗效监测中的价值。方法92例白血病和造血干细胞移植(hematopoietic stem celltransplants,HSCT)患者纳入实验研究,共测定标本290份。采用ELISA方法检测血清中的GM,检测浓度可达到0.5ng/ml。结果以1.5为阳性界值,GM检测的敏感性为60%,特异性100%,诊断符合率88%;以0.8为阳性界值,敏感性为90%,特异性95%,诊断符合率94%。连续监测时GM可早于真菌培养方法2～20d预测曲霉感染。在GM阳性患者中,对13例病人进行抗曲霉治疗,10例有效,3例无效死亡。抗曲霉治疗前GM水平呈缓慢上升趋势,保持在较高水平,抗真菌治疗有效病人的GM含量呈下降趋势,无效死亡病人呈上升趋势。结论血清GM检测是对白血病和HSCT患者IA的早期诊断和疗效评价的有用指标。
Objective To evaluate the value of continuous detection of serum galactomannan (GM) antigen in the early diagnosis and treatment of invasive aspergillosis (IA) by enzyme-linked immunosorbent assay (ELISA). Methods Ninety-two patients with leukemia and hematopoietic stem cell transplantation (HSCT) were enrolled in this study. A total of 290 samples were collected. Serum GM was detected by ELISA, the detection concentration reached 0.5ng / ml. The results of 1.5 positive cutoff, the sensitivity of GM detection of 60%, specificity 100%, the diagnostic coincidence rate of 88%; 0.8 positive cutoff, the sensitivity was 90% and specificity of 95%, the diagnostic coincidence rate of 94 %. Aspergillus infection can be predicted by GM 2 ~ 20d earlier than fungal culture. In GM-positive patients, 13 patients were treated with Aspergillus niger, 10 were effective and 3 were ineffective. The level of GM before anti-Aspergillus treatment showed a slow upward trend, maintained at a high level, anti-fungal treatment of patients with a downward trend in GM content, ineffective deaths were on the rise. Conclusion Serum GM test is a useful index for the early diagnosis and evaluation of IA in patients with leukemia and HSCT.