半乳甘露聚糖在临床实践中的应用：提供免费检测并非万全之策。
Galactomannan use in clinical practice: providing free testing is not the full answer.
作者信息
Dos Santos Jeniffer S, Hermes Djuli M, Pasqualotto Alessandro C
机构信息
Centro Universitário Ritter dos Reis (UniRitter), Porto Alegre, RS, Brazil.
Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
出版信息
Braz J Infect Dis. 2018 Jan-Feb;22(1):37-40. doi: 10.1016/j.bjid.2017.11.002. Epub 2017 Nov 22.
INTRODUCTION
Invasive aspergillosis is a condition associated with a high mortality rate mostly due to difficulties in performing an early diagnosis. In recent years, galactomannan detection has markedly improved the diagnosis of invasive aspergillosis, but very little is known on how physicians deal with this test in clinical practice.
METHODS
This cross-sectional study aimed to analyze the indications for the use of serum galactomannan in a large Brazilian hospital, between 2015 and 2016. No specific protocol was in place for GM request. We reviewed the medical records of adult (>18 years-old) patients who were tested for galactomannan due to one the following indications: screening, diagnosis, or treatment follow-up. Additional variables included demographic data, underlying diseases, presence of neutropenia, and use of previous antifungal (anti-Aspergillus) drugs.
RESULTS
The mean age of the patients was 51 years-old (sd±15.8), and 63.3% of patients were male. Patients with hematological malignancies accounted for 60.1% of the cases, mostly acute myeloid leukemia (19.6%). Galactomannan testing was positive in 12.2% of patients, including 1.6% of occasions in which the test was used for screening purposes, 13.2% for diagnosis, and 32.4% during follow-up. Median time for chest imaging request was two days before GM testing. Previous antifungal therapy was reported for 35.1% of patients, mostly amphotericin B (57.1%).
CONCLUSION
The correct use of galactomannan testing is essential for an early diagnosis of invasive aspergillosis, which may improve the prognosis of the disease. We demonstrated that clinicians usually ask for galactomannan tests to confirm imaging findings in patients who frequently were on antifungal drugs, something that could be improved by medical education. We observed a low frequency of galactomannan use for preemptive antifungal therapy (25.7%), which is worrying considering the well-known beneficial use of GM testing in this scenario.
引言
侵袭性曲霉病是一种死亡率很高的疾病，主要原因是早期诊断困难。近年来，半乳甘露聚糖检测显著改善了侵袭性曲霉病的诊断，但对于医生在临床实践中如何处理该检测知之甚少。
方法
这项横断面研究旨在分析2015年至2016年期间巴西一家大型医院使用血清半乳甘露聚糖的指征。对于半乳甘露聚糖检测申请没有具体的方案。我们回顾了因以下指征之一接受半乳甘露聚糖检测的成年（>18岁）患者的病历：筛查、诊断或治疗随访。其他变量包括人口统计学数据、基础疾病、中性粒细胞减少症的存在以及先前抗真菌（抗曲霉）药物的使用情况。
结果
患者的平均年龄为51岁（标准差±15.8），63.3%的患者为男性。血液系统恶性肿瘤患者占病例的60.1%，主要是急性髓系白血病（19.6%）。12.2%的患者半乳甘露聚糖检测呈阳性，其中该检测用于筛查目的的占1.6%，用于诊断的占13.2%，随访期间占32.4%。胸部影像学检查申请的中位时间是在半乳甘露聚糖检测前两天。35.1%的患者报告曾接受过抗真菌治疗，主要是两性霉素B（57.1%）。
结论
正确使用半乳甘露聚糖检测对于侵袭性曲霉病的早期诊断至关重要，这可能改善疾病的预后。我们证明临床医生通常会要求进行半乳甘露聚糖检测以确认经常使用抗真菌药物的患者的影像学检查结果，这一点可以通过医学教育得到改善。我们观察到半乳甘露聚糖用于先发制人抗真菌治疗的频率较低（25.7%），考虑到在这种情况下半乳甘露聚糖检测的有益用途广为人知，这令人担忧。
Zotero 插件