Department of Medicine, University of Texas Health Medical School, Houston, Texas 77030, USA.
Am J Med. 2012 Jan;125(1 Suppl):S14-24. doi: 10.1016/j.amjmed.2011.10.008.
Despite the availability of newer antifungal drugs, outcomes for patients with invasive fungal infections (IFIs) continue to be poor, in large part due to delayed diagnosis and initiation of appropriate antifungal therapy. Standard histopathologic diagnostic techniques are often untenable in at-risk patients, and culture-based diagnostics typically are too insensitive or nonspecific, or provide results after too long a delay for optimal IFI management. Newer surrogate markers of IFIs with improved sensitivity and specificity are needed to enable earlier diagnosis and, ideally, to provide prognostic information and/or permit therapeutic monitoring. Surrogate assays should also be accessible and easy to implement in the hospital. Several nonculture-based assays of newer surrogates are making their way into the medical setting or are currently under investigation. These new or up-and-coming surrogates include antigens/antibodies (mannan and antimannan antibodies) or fungal metabolites (d-arabinitol) for detection of invasive candidiasis, the Aspergillus cell wall component galactomannan used to detect invasive aspergillosis, or the fungal cell wall component and panfungal marker β-glucan. In addition, progress continues with use of polymerase chain reaction- or other nucleic acid- or molecular-based assays for diagnosis of either specific or generic IFIs, although the various methods must be better standardized before any of these approaches can be more fully implemented into the medical setting. Investigators are also beginning to explore the possibility of combining newer surrogate markers with each other or with more standard diagnostic approaches to improve sensitivity, specificity, and capacity for earlier diagnosis, at a time when fungal burden is still relatively low and more responsive to antifungal therapy.
尽管有更新的抗真菌药物，但侵袭性真菌感染 (IFI) 患者的治疗结果仍然不佳，这在很大程度上是由于诊断延迟和未能及时开始适当的抗真菌治疗。在高危患者中，标准的组织病理学诊断技术通常不可行，而基于培养的诊断技术通常不够敏感或特异性，或者提供结果的时间过长，无法进行最佳的 IFI 管理。需要新的 IFI 替代标志物，以提高敏感性和特异性，从而实现更早的诊断，理想情况下，提供预后信息和/或允许进行治疗监测。替代检测还应易于在医院获得和实施。几种新的非培养替代物检测正在进入医疗环境或正在研究中。这些新的或新兴的替代物包括抗原/抗体（甘露聚糖和抗甘露聚糖抗体）或真菌代谢物（D-阿拉伯糖醇），用于检测侵袭性念珠菌病；用于检测侵袭性曲霉病的曲霉细胞壁成分半乳甘露聚糖；或真菌细胞壁成分和全真菌标志物β-葡聚糖。此外，聚合酶链反应或其他核酸或分子检测方法用于诊断特定或通用 IFI 的应用也在不断取得进展，尽管在这些方法能够更全面地应用于医疗环境之前，必须对各种方法进行更好的标准化。研究人员也开始探索将新的替代标志物彼此结合或与更标准的诊断方法相结合，以提高敏感性、特异性和更早诊断的能力，因为此时真菌负荷仍然相对较低，对抗真菌治疗的反应性更好。
