β-D-葡聚糖在肿瘤血液病患者侵袭性念珠菌病的诊断和随访中的作用。

Usefulness of ß-D-glucan for diagnosis and follow-up of invasive candidiasis in onco-haematological patients.

机构信息

AP-HP, Hôpital St Antoine, Service de Parasitologie-Mycologie, 34 rue Crozatier, F-75012 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, Inserm UMR S 1135, CNRS ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 Bd de l'hôpital, F-75013 Paris.

AP-HP, Hôpital St Antoine, Service d'Hématologie Clinique, 34 rue Crozatier, F-75012 Paris, France.

出版信息

J Infect. 2018 May;76(5):483-488. doi: 10.1016/j.jinf.2018.01.011. Epub 2018 Feb 9.

DOI:10.1016/j.jinf.2018.01.011

PMID:29432826

Abstract

OBJECTIVES

Definitive diagnosis of invasive candidiasis (IC) may be difficult to achieve in patients with haematological malignancy (PHM). We aimed to evaluate the performance of BDG for the diagnosis and the follow-up of IC in PHM.

PATIENTS AND METHODS

We retrospectively reviewed the serological data of BDG assay in adult and paediatric PHM, who developed candidemia or chronic disseminated candidiasis (CDC) through a 4-year period. Sensitivity and kinetics of BDG were determined for both clinical forms.

RESULTS

In a panel of 3027 PHM, incidence rates of candidemia and CDC ranged between 0.74 and 0.77 and 0.30 and 0.44 according to the group of patients. At the time of diagnosis, 43.5% and 73% of cases of candidemia and CDC had a positive BDG assay, respectively. We found a significant correlation between the level of BDG at diagnosis and the outcome of candidemia (p = 0.022). In all cases of CDC, BDG negative results were obtained 2 to 6 months before recovery of the CT-scan lesions.

CONCLUSIONS

BDG exhibits a low sensitivity to detect IC in PHM, but its kinetics correlates the clinical outcome. Additional studies are warranted in patients with CDC to evaluate the interest of monitoring BDG levels to anticipate the discontinuation of antifungal maintenance therapy.

摘要

目的

血液恶性肿瘤（PHM）患者侵袭性念珠菌病（IC）的明确诊断可能较为困难。本研究旨在评估 1，3-β-D-葡聚糖（BDG）检测在 PHM 患者 IC 诊断和随访中的作用。

方法

我们回顾性分析了 4 年内发生念珠菌血症或慢性播散性念珠菌病（CDC）的成年和儿科 PHM 患者的 BDG 检测血清学数据。确定了这两种临床形式的 BDG 检测的敏感性和动力学。

结果

在 3027 例 PHM 患者中，根据患者组，念珠菌血症和 CDC 的发生率分别为 0.74%至 0.77%和 0.30%至 0.44%。在诊断时，分别有 43.5%和 73%的念珠菌血症和 CDC 病例的 BDG 检测呈阳性。我们发现 BDG 检测水平与念珠菌血症的转归之间存在显著相关性（p=0.022）。在所有 CDC 病例中，BDG 检测结果在 CT 扫描病变恢复前 2 至 6 个月均为阴性。