Verdaguer Virginia, Walsh Thomas J, Hope William, Cortez Karoll J
National Cancer Institute, Immunocompromissed Host Section, Pediatric Oncology Branch, National Institutes of Health, 9000 Rockville Pike 10, Center Dr. CRC 1-W-5752, Bethesda, MD 20892-1100, USA.
Expert Rev Mol Diagn. 2007 Jan;7(1):21-32. doi: 10.1586/14737159.7.1.21.
Invasive aspergillosis is a serious and lethal infection among immunocompromised patients, with reported mortality rates as high as 74-92%. The high mortality is related to the severe immunosuppression experienced by these patients as well as the difficulties for physicians in arriving at a timely diagnosis. Definitive diagnostic procedures (tissue biopsy for histopathology and culture) are often precluded by severe cytopenias and coagulation abnormalities. The development of minimally invasive, nonculture diagnostic methods is a major advance in the early diagnosis of invasive aspergillosis. Galactomannan is a heteropolysaccharide (mannan core and side residues of galactofuranosyl units) present in the cell wall of Aspergillus spp. The double sandwich enzyme immunoassay, which detects galactomannan in serum samples, has been available in Europe for almost a decade and in the USA since May 2003, for the diagnosis of invasive aspergillosis. However, availability of the double galactomannan enzyme immunoassay is center variable in the USA and, although its analytical performance in the diagnosis of invasive aspergillosis is well documented, its routine use in clinical practice is limited. As an adjunct in the diagnosis and management of invasive aspergillosis, incorporation of the galactomannan enzyme immunoassay into clinical trials will help to further define its role.
侵袭性曲霉病在免疫功能低下患者中是一种严重且致命的感染，报告的死亡率高达74% - 92%。高死亡率与这些患者经历的严重免疫抑制以及医生及时做出诊断的困难有关。明确的诊断程序（组织活检用于组织病理学和培养）常常因严重的血细胞减少和凝血异常而无法进行。微创、非培养诊断方法的发展是侵袭性曲霉病早期诊断的一项重大进展。半乳甘露聚糖是曲霉属细胞壁中存在的一种杂多糖（甘露聚糖核心和半乳呋喃糖基单位的侧链残基）。检测血清样本中半乳甘露聚糖的双夹心酶免疫测定法在欧洲已可用近十年，在美国自2003年5月起用于侵袭性曲霉病的诊断。然而，双半乳甘露聚糖酶免疫测定法在美国各地的可用性存在差异，并且尽管其在侵袭性曲霉病诊断中的分析性能有充分记录，但其在临床实践中的常规应用仍然有限。作为侵袭性曲霉病诊断和管理的辅助手段，将半乳甘露聚糖酶免疫测定法纳入临床试验将有助于进一步明确其作用。
