Kawazu Masahito, Kanda Yoshinobu, Nannya Yasuhito, Aoki Katsunori, Kurokawa Mineo, Chiba Shigeru, Motokura Toru, Hirai Hisamaru, Ogawa Seishi
Department of Hematology and Oncology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
J Clin Microbiol. 2004 Jun;42(6):2733-41. doi: 10.1128/JCM.42.6.2733-2741.2004.
The establishment of an optimal noninvasive method for diagnosing invasive aspergillosis (IA) is needed to improve the management of this life-threatening infection in patients with hematological disorders, and a number of noninvasive tests for IA that target different fungal components, including galactomannan, (1-->3)-beta-d-glucan (BDG), and Aspergillus DNA, have been developed. In this study, we prospectively evaluated the diagnostic potential of three noninvasive tests for IA that were used in a weekly screening strategy: the double-sandwich enzyme-linked immunosorbent assay (ELISA) for galactomannan (Platelia Aspergillus), a real-time PCR assay for Aspergillus DNA (GeniQ-Asper), and an assay for BDG (beta-glucan Wako). We analyzed 149 consecutive treatment episodes in 96 patients with hematological disorders who were at high risk for IA and diagnosed 9 proven IA cases, 2 probable IA cases, and 13 possible invasive fugal infections. In a receiver-operating characteristic (ROC) analysis, the area under the ROC curve was greatest for ELISA, using two consecutive positive results (0.97; P = 0.036 for ELISA versus PCR, P = 0.055 for ELISA versus BDG). Based on the ROC curve, the cutoff for the ELISA could be reduced to an optical density index (O.D.I.) of 0.6. With the use of this cutoff for ELISA and cutoffs for PCR and BDG that give a comparable level of specificity, the sensitivity/specificity/positive predictive value/negative predictive value of the ELISA and the PCR and BDG tests were 1.00/0.93/0.55/1.00, 0.55/0.93/0.40/0.96, and 0.55/0.93/0.40/0.96, respectively. In conclusion, among these weekly screening tests for IA, the double-sandwich ELISA test was the most sensitive at predicting the diagnosis of IA in high-risk patients with hematological disorders, using a reduced cutoff of 0.6 O.D.I.
为改善血液系统疾病患者中这种危及生命的感染的管理,需要建立一种诊断侵袭性曲霉病(IA)的最佳非侵入性方法,并且已经开发了多种针对不同真菌成分(包括半乳甘露聚糖、(1→3)-β-D-葡聚糖(BDG)和曲霉DNA)的IA非侵入性检测方法。在本研究中,我们前瞻性评估了三种用于IA的非侵入性检测方法在每周筛查策略中的诊断潜力:半乳甘露聚糖双夹心酶联免疫吸附测定(ELISA)(Platelia Aspergillus)、曲霉DNA实时聚合酶链反应测定(GeniQ-Asper)和BDG测定(β-葡聚糖和光纯药)。我们分析了96例有IA高风险的血液系统疾病患者的149个连续治疗过程,诊断出9例确诊IA病例、2例可能IA病例和13例可能的侵袭性真菌感染。在受试者操作特征(ROC)分析中,连续两次阳性结果时ELISA的ROC曲线下面积最大(0.97;ELISA与PCR比较P = 0.036,ELISA与BDG比较P = 0.055)。基于ROC曲线,ELISA的临界值可降至光密度指数(O.D.I.)为0.6。使用该ELISA临界值以及PCR和BDG的具有可比特异性水平的临界值时,ELISA、PCR和BDG检测的灵敏度/特异性/阳性预测值/阴性预测值分别为1.00/0.93/0.55/1.00、0.55/0.93/0.40/0.96和0.55/0.93/0.40/0.96。总之,在这些IA每周筛查检测中,双夹心ELISA检测在预测血液系统疾病高风险患者的IA诊断时最为敏感,使用降低至0.6 O.D.I.的临界值。