（1-->3）-β-D-葡聚糖检测法对侵袭性真菌感染的诊断性能。

Diagnostic performance of the (1-->3)-beta-D-glucan assay for invasive fungal disease.

机构信息

Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, and 4Harvard School of Public Health, Boston, Massachusetts 02115, USA.

出版信息

Clin Infect Dis. 2009 Dec 1;49(11):1650-9. doi: 10.1086/647942.

DOI:10.1086/647942

PMID:19863452

Abstract

BACKGROUND

Diagnosis of invasive fungal disease (IFD) is challenging, and it remains a significant cause of morbidity and mortality in immunocompromised patients. The (1-->3)-beta-D-glucan (BG) assay may be a useful adjunct, but its diagnostic performance is not well characterized.

METHODS

We retrospectively assessed the diagnostic indices of the BG assay in patients at risk of IFD who had a compatible clinical syndrome for the diagnosis of IFD a week after initial BG testing and at the end of the hospitalization associated with the first BG value. Patients with IFD were classified according to current European Organization for Research and Treatment of Cancer-Mycoses Study Group criteria, independent of BG results.

RESULTS

A total of 1308 BG assays were performed for 871 patients. One hundred twelve proven or probable IFD cases were diagnosed within 1 week after initial testing, and 116 cases were diagnosed by the end of hospitalization. Sensitivity of an initial BG level 80 pg/mL for IFD at 1 week was 0.64 (95% confidence interval [CI], 0.55-0.73), specificity was 0.84 (95% CI, 0.81-0.86), the positive likelihood ratio was 3.93 (95% CI, 2.94-5.26), and the negative likelihood ratio was 0.43 (95% CI, 0.31-0.59). Albumin, intravenous immunoglobulin, and hemodialysis were associated with elevated BG levels in patients without IFD (odds ratio, 4.78; 95% CI, 2.59-8.80). After excluding patients with these factors, specificity and the positive likelihood ratio of an initial BG level 80 pg/mL increased slightly. Empirical systemic antifungal treatment did not reduce overall BG sensitivity. Sensitivity was slightly lower among patients with hematologic malignancy or stem cell transplantation. Consideration of BG results would have increased the diagnostic certainty to probable in 54% of possible IFD cases.

CONCLUSIONS

BG level appears to be a fair diagnostic adjunct for IFD in patients with appropriate pretest probability and a suggestive clinical syndrome, especially when checked serially in patients not receiving factors associated with an elevated BG level in the absence of IFD.

摘要

背景

侵袭性真菌病（IFD）的诊断具有挑战性，它仍然是免疫功能低下患者发病率和死亡率的重要原因。（1-->3）-β-D-葡聚糖（BG）检测可能是一种有用的辅助手段，但它的诊断性能尚未得到很好的描述。

方法

我们回顾性评估了在最初 BG 检测后一周内有 IFD 相关临床综合征且与第一次 BG 值相关住院期间结束时具有 IFD 风险的患者中 BG 检测的诊断指标。根据当前的欧洲癌症研究与治疗组织-真菌病研究组标准，将 IFD 患者进行分类，与 BG 结果无关。

结果

共对 871 名患者进行了 1308 次 BG 检测。在最初检测后 1 周内诊断了 112 例确诊或疑似 IFD 病例，在住院期间结束时诊断了 116 例。初始 BG 水平为 80 pg/mL 时，1 周内 IFD 的敏感性为 0.64（95%置信区间[CI]，0.55-0.73），特异性为 0.84（95%CI，0.81-0.86），阳性似然比为 3.93（95%CI，2.94-5.26），阴性似然比为 0.43（95%CI，0.31-0.59）。在没有 IFD 的患者中，白蛋白、静脉注射免疫球蛋白和血液透析与升高的 BG 水平相关（比值比，4.78；95%CI，2.59-8.80）。排除具有这些因素的患者后，初始 BG 水平为 80 pg/mL 的特异性和阳性似然比略有增加。经验性全身抗真菌治疗并未降低总体 BG 敏感性。血液恶性肿瘤或干细胞移植患者的敏感性略低。考虑 BG 结果会使 54%的可能 IFD 病例的诊断确定性增加到可能。