Hurst S F, Reyes G H, McLaughlin D W, Reiss E, Morrison C J
Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Clin Diagn Lab Immunol. 2000 May;7(3):477-85. doi: 10.1128/CDLI.7.3.477-485.2000.
A commercial latex agglutination assay (LA) and a sandwich enzyme immunoassay (SEIA) (Sanofi Diagnostics Pasteur, Marnes-la-Coquette, France) were compared with a competitive binding inhibition assay (enzyme immunoassay [EIA]) to determine the potential uses and limitations of these antigen detection tests for the sensitive, specific, and rapid diagnosis of invasive aspergillosis (IA). Toward this end, well-characterized serum and urine specimens were obtained by using a rabbit model of IA. Serially collected serum or urine specimens were obtained daily from control rabbits or from rabbits immunosuppressed and infected systemically with Aspergillus fumigatus. By 4 days after infection, EIA, LA, and SEIA detected antigen in the sera of 93, 93, and 100% of A. fumigatus-infected rabbits, respectively, whereas antigen was detected in the urine of 93, 100, and 100% of the rabbits, respectively. False-positive results for non-A. fumigatus-infected rabbits for EIA, LA, and SEIA were as follows: for serum, 14, 11, and 23%, respectively; for urine, 14, 84, and 90%, respectively. Therefore, although the sensitivities of all three tests were similar, the specificity was generally greater for EIA than for LA or SEIA. Infection was also detected earlier by EIA, by which the serum of 53% of A. fumigatus-infected rabbits was positive as early as 1 day after infection, whereas the serum of only 27% of the rabbits tested by LA was positive. Although the serum of 92% of A. fumigatus-infected rabbits was positive by SEIA as early as 1 day after infection, the serum of a high percentage (50%) was false positive before infection. The urine of 21% of A. fumigatus-infected rabbits was positive by EIA as early as 1 day after infection, and the urine of none of the rabbits was false positive before infection. When EIA results for urine specimens were combined with those for serum, sensitivity was improved (i.e., 67% of rabbits were positive by 1 day after infection and only one rabbit gave a false-positive result). A total of 93% of A. fumigatus-infected rabbits were positive for antigen in urine as early as 1 day after infection and the urine of 100% of the rabbits was positive by SEIA. However, before infection, 79% of A. fumigatus-infected rabbits were false positive for antigen in urine by LA and 90% were false positive for antigen in urine by SEIA. These data indicate that the EIA has the potential to be used to diagnose IA with both serum and urine specimens and to detect a greater number of infections earlier with greater specificity than the specificities achieved with the commercial tests.
将一种商业乳胶凝集试验（LA）和一种夹心酶免疫测定法（SEIA）（赛诺菲巴斯德诊断公司，法国马恩拉科凯特）与一种竞争性结合抑制试验（酶免疫测定法[EIA]）进行比较，以确定这些抗原检测试验在侵袭性曲霉病（IA）的灵敏、特异和快速诊断中的潜在用途及局限性。为此，通过使用IA的兔模型获得了特征明确的血清和尿液标本。每天从对照兔或免疫抑制并全身感染烟曲霉的兔中连续采集血清或尿液标本。感染后4天，EIA、LA和SEIA分别在93%、93%和100%的烟曲霉感染兔血清中检测到抗原，而在兔尿液中检测到抗原的比例分别为93%、100%和100%。对于非烟曲霉感染兔，EIA、LA和SEIA的假阳性结果如下：血清分别为14%、11%和23%；尿液分别为14%、84%和90%。因此，尽管这三种试验的敏感性相似，但EIA的特异性总体上高于LA或SEIA。EIA也能更早地检测到感染，53%的烟曲霉感染兔血清在感染后1天就呈阳性，而LA检测的兔血清中只有27%呈阳性。尽管92%的烟曲霉感染兔血清早在感染后1天通过SEIA呈阳性，但在感染前有高比例（50%）为假阳性。21%的烟曲霉感染兔尿液早在感染后1天通过EIA呈阳性，且在感染前没有一只兔的尿液呈假阳性。当将尿液标本的EIA结果与血清结果相结合时，敏感性得到提高（即67%的兔在感染后1天呈阳性，只有一只兔出现假阳性结果）。早在感染后1天，93%的烟曲霉感染兔尿液中抗原呈阳性，100%的兔尿液通过SEIA呈阳性。然而，在感染前，79%的烟曲霉感染兔尿液中抗原通过LA呈假阳性，90%的兔尿液中抗原通过SEIA呈假阳性。这些数据表明，EIA有潜力用于通过血清和尿液标本诊断IA，并能比商业检测方法以更高的特异性更早地检测到更多感染。
