Asano-Mori Yuki, Kanda Yoshinobu, Oshima Kumi, Kako Shinichi, Shinohara Akihito, Nakasone Hideki, Kaneko Makoto, Sato Hiroyuki, Watanabe Takuro, Hosoya Noriko, Izutsu Koji, Asai Takashi, Hangaishi Akira, Motokura Toru, Chiba Shigeru, Kurokawa Mineo
Department of Hematology and Oncology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
J Antimicrob Chemother. 2008 Feb;61(2):411-6. doi: 10.1093/jac/dkm463. Epub 2007 Nov 30.
Although Aspergillus galactomannan (GM) antigen detection is widely applied in the diagnosis of invasive aspergillosis (IA), false-positive reactions with fungus-derived antibiotics, other fungal genera or the passage of dietary GM through injured mucosa are a matter of concern. The aim of this study was to investigate the cumulative incidence and risk factors for false-positive GM antigenaemia.
The records of 157 adult allogeneic haematopoietic stem cell transplantation (HSCT) recipients were retrospectively analysed. Episodes of positive GM antigenaemia, defined as two consecutive GM results with an optical density index above 0.6, were classified into true, false and inconclusive GM antigenaemia by reviewing the clinical course.
Twenty-five patients developed proven or probable IA with a 1 year cumulative incidence of 12.9%, whereas 50 experienced positive GM antigenaemia with an incidence of 32.2%. Among the total 58 positive episodes of the 50 patients, 29 were considered false-positive. The positive predictive value (PPV) was lower during the first 100 days than beyond 100 days after HSCT (37.5% versus 58.8%). Gastrointestinal chronic graft-versus-host disease (GVHD) was identified as the only independent significant factor for the increased incidence of false-positive GM antigenaemia (PPV 0% versus 66.7%, P = 0.02).
GM antigen results must be considered cautiously in conjunction with other diagnostic procedures including computed tomography scans, especially during the first 100 days after HSCT and in patients with gastrointestinal chronic GVHD.
尽管曲霉半乳甘露聚糖（GM）抗原检测广泛应用于侵袭性曲霉病（IA）的诊断，但真菌衍生抗生素、其他真菌属或膳食GM通过受损黏膜引起的假阳性反应令人担忧。本研究旨在调查假阳性GM血症的累积发病率及危险因素。
回顾性分析157例成年异基因造血干细胞移植（HSCT）受者的记录。GM血症阳性发作定义为连续两次GM结果的光密度指数高于0.6，通过回顾临床病程将其分为真、假和不确定的GM血症。
25例患者确诊或可能患有IA，1年累积发病率为12.9%，而50例出现GM血症阳性，发病率为32.2%。在这50例患者的58次阳性发作中，29次被认为是假阳性。HSCT后前100天的阳性预测值（PPV）低于100天后（37.5%对58.8%）。胃肠道慢性移植物抗宿主病（GVHD）被确定为假阳性GM血症发病率增加的唯一独立显著因素（PPV 0%对66.7%，P = 0.02）。
GM抗原检测结果必须结合包括计算机断层扫描在内的其他诊断程序谨慎考虑，尤其是在HSCT后的前100天以及患有胃肠道慢性GVHD的患者中。
