Jin Jin, Sun Tie-ying, Hu Yun-jian, Li Yan-ming
Department of Respiratory Medicine of Beijing Hospital, Beijing 100730, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2010 Sep;33(9):660-4.
To evaluate the value of plasma 1, 3-β-D-glucan (G), serum mannan, galactomannan (GM) and cryptococcus capsular antigen assays for diagnosis of invasive fungal infections (IFI) in non-neutropenic adult patients.
This was a prospective case control study. Plasma and serum samples from 25 patients with IFI (candidiasis, aspergillosis, cryptococcosis, zygomycosis, pneumocystis carinii pneumonia), 27 patients with bacterial infections, and 25 healthy adults were collected from February 2007 to February 2009 in Beijing Hospital. The serum antigenic assays were performed and their sensitivity and specificity were analyzed. Optimal cut-off level of G test and mannan was established with receiver operating characteristic curve (ROC).
The concentration of G test in plasma of patients with IFI [89.4 (25.8, 336.9) ng/L] was significantly higher than that of patients with bacterial infection [8.1 (5.0, 34.9) ng/L, U = 120.5, P < 0.001] and healthy adults [3.8 (3.8, 26.0) ng/L, U = 76.5, P < 0.001]. The area under curve (AUC) was 0.858, and the optimal cut-off value was 71.7 ng/L. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 65.0% (13/20), 92.3% (48/52), 76.5% (13/17) and 87.2% (48/55) respectively. The concentration of mannan in serum from patients with candidiasis [1.13 (0.44, 1.22) µg/L] was significantly higher than that from patients with non-candidiasis IFI [0.21 (0.14, 0.27) µg/L, U = 19, P < 0.05], bacterial infection [0.26 (0.22, 0.32) µg/L, U = 36.5, P < 0.001] and healthy adults [0.25 (0.22, 0.30) µg/L, U = 29.5, P < 0.001]. The AUC was 0.894, and the optimal cut-off value was 0.41 µg/L. The sensitivity, specificity, PPV and NPV were 83.3% (10/12), 90.4% (47/52), 66.7% (10/15) and 96.0% (47/49) respectively. The sensitivity, specificity, PPV and NPV of GM antigen to diagnose aspergillosis were 25.0% (1/4), 96.1% (50/52), 33.3% (1/3) and 92.6% (50/54) respectively. The sensitivity, specificity, PPV and NPV of cryptococcus capsular antigen to diagnose cryptococcosis were all 100%.
1,3-β-D-glucan, mannan and cryptococcus capsular antigen were useful for diagnosis of IFI in non-neutropenic adult patients. GM antigen did not show a good sensitivity for diagnosis of aspergillosis in non-neutropenic adult patients.
评估血浆1,3-β-D-葡聚糖（G）、血清甘露聚糖、半乳甘露聚糖（GM）及隐球菌荚膜抗原检测对非中性粒细胞减少成年患者侵袭性真菌感染（IFI）的诊断价值。
这是一项前瞻性病例对照研究。2007年2月至2009年2月在北京医院收集了25例IFI患者（念珠菌病、曲霉病、隐球菌病、接合菌病、卡氏肺孢子虫肺炎）、27例细菌感染患者及名健康成年人的血浆和血清样本。进行血清抗原检测并分析其敏感性和特异性。采用受试者工作特征曲线（ROC）确定G试验和甘露聚糖的最佳截断水平。
IFI患者血浆中G试验浓度[89.4（25.8，336.9）ng/L]显著高于细菌感染患者[8.1（5.0，34.9）ng/L，U = 120.5，P < 0.001]和健康成年人[3.8（3.8，26.0）ng/L，U = 76.5，P < 0.001]。曲线下面积（AUC）为0.858，最佳截断值为71.7 ng/L。敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为65.0%（13/20）、92.3%（48/52）、76.5%（13/17）和87.2%（48/55）。念珠菌病患者血清中甘露聚糖浓度[1.13（0.44，1.22）μg/L]显著高于非念珠菌病IFI患者[0.21（0.14，0.27）μg/L，U = 19，P < 0.05]、细菌感染患者[0.26（0.22，0.32）μg/L，U = 36.5，P < 0.001]和健康成年人[0.25（0.22，0.30）μg/L，U = 29.5，P < 0.001]。AUC为0.894，最佳截断值为0.41μg/L。敏感性、特异性、PPV和NPV分别为83.3%（10/12）、90.4%（47/52）、66.7%（10/15）和96.0%（47/49）。GM抗原诊断曲霉病的敏感性、特异性、PPV和NPV分别为25.0%（1/4）、96.1%（50/52）、33.3%（1/3）和92.6%（50/54）。隐球菌荚膜抗原诊断隐球菌病的敏感性、特异性、PPV和NPV均为100%。
1,3-β-D-葡聚糖、甘露聚糖及隐球菌荚膜抗原对非中性粒细胞减少成年患者IFI的诊断有一定价值。GM抗原对非中性粒细胞减少成年患者曲霉病的诊断敏感性欠佳。
