Cai Xuejiu, Ni Wentao, Wei Chuanqi, Cui Junchang
Department of Respiratory Diseases, Chinese People's Liberation Army General Hospital, China.
Intern Med. 2014;53(21):2433-7. doi: 10.2169/internalmedicine.53.2381. Epub 2014 Nov 1.
Galactomannan (GM) and (1, 3)-β-D-glucan (BG) are considered useful seromarkers for the diagnosis of invasive pulmonary aspergillosis (IPA) in patients with neutropenia. However, there is still limited data on these seromarkers for testing non-neutropenic patients who are at the risk of IPA. The aim of this study was to evaluate the value of these two serum antigen assays for the early diagnosis of IPA in patients without neutropenia.
Between January 2011 and December 2012, 97 patients with suspected IPA admitted to the department of respiratory diseases and the respiratory intensive care unit were prospectively monitored. Serum GM and BG assays were performed before the patients received antifungal therapy.
Patients were classified as proven IPA (n=11), probable IPA (n=16), possible IPA (n=4), or non-IPA (n=66). The most common underlying disease of patients with IPA was chronic obstructive pulmonary disease (18.5%), and 22.2% patients with IPA had no known diseases. The sensitivities, specificities, and positive and negative predictive values of the GM and BG assays and at least one positive on both assays were 40.7%/89.4%/61.1%/78.7%, 48.1%/78.8%/48.1%/78.8%, and 70.4%/75.8%/54.3%/86.2%, respectively.
Compared with the testing of neutropenic patients, the serum GM or BG assay alone was less useful for the diagnosis of IPA in non-neutropenic patients. However, at least one positive result of the two serum assays appeared to be useful in the diagnosis of IPA in non-neutropenic patients.
半乳甘露聚糖（GM）和（1,3）-β-D-葡聚糖（BG）被认为是诊断中性粒细胞减少患者侵袭性肺曲霉病（IPA）的有用血清标志物。然而，关于这些血清标志物用于检测有IPA风险的非中性粒细胞减少患者的数据仍然有限。本研究的目的是评估这两种血清抗原检测方法对非中性粒细胞减少患者IPA早期诊断的价值。
2011年1月至2012年12月，对收治于呼吸内科和呼吸重症监护病房的97例疑似IPA患者进行前瞻性监测。在患者接受抗真菌治疗前进行血清GM和BG检测。
患者分为确诊IPA（n = 11）、拟诊IPA（n = 16）、可能IPA（n = 4）或非IPA（n = 66）。IPA患者最常见的基础疾病是慢性阻塞性肺疾病（18.5%），22.2%的IPA患者无已知疾病。GM检测、BG检测以及两者至少一项为阳性的敏感性、特异性、阳性预测值和阴性预测值分别为40.7%/89.4%/61.1%/78.7%、48.1%/78.8%/48.1%/78.8%和70.4%/75.8%/54.3%/86.2%。
与中性粒细胞减少患者的检测相比，单独的血清GM或BG检测对非中性粒细胞减少患者IPA的诊断价值较小。然而，两种血清检测中至少一项为阳性结果似乎对非中性粒细胞减少患者IPA的诊断有用。
