Nakamura Shingen, Maeda Yusaku, Sumitani Ryohei, Oura Masahiro, Sogabe Kimiko, Yagi Hikaru, Fujii Shiro, Harada Takeshi, Matsuoka Ken-Ichi, Miki Hirokazu
Department of Community Medicine and Medical Science, Tokushima University Graduate School of Biomedical Sciences, Tokushima 7708503, Japan.
Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima 7708503, Japan.
Diseases. 2025 Apr 17;13(4):118. doi: 10.3390/diseases13040118.
BACKGROUND/OBJECTIVES: Invasive pulmonary aspergillosis (IA) is a common infectious disease in patients with hematological diseases. The prevention, early detection, and establishment of treatment strategies for IA are important. The serum galactomannan antigen (GM) mycological test for IA diagnosis, included in the mycology criteria of the European Organization for Research and Treatment of Cancer-Invasive Fungal Infections Cooperative Group/National Institute of Allergy and Infectious Diseases Mycosis Study Group (EORTC/MSG), is widely used because of its high sensitivity and specificity. However, false-positive results are a concern.
We retrospectively analyzed all GM tests performed at our department in the clinical practice setting between April 2003 and January 2012.
Of the 330 cases and 2155 samples analyzed, 540 (25%) were positive (≥0.5). Among the underlying diseases, positivity rates were the highest for multiple myeloma (MM), with 61.3%. By type, positivity rates for IgG, IgA, Bence-Jones protein, and IgD were 71.7%, 33.3%, 57.1%, and 34.6%, respectively. Seventeen out of eighteen cases that were GM-positive at MM diagnosis were false positives, according to the 2008 EORTC/MSG criteria. The IgG and GM values were not directly correlated. Of the seventeen false-positive cases identified, two developed IA during anti-myeloma treatments, and GM values did not become negative during the treatment in most cases.
Although subclinical IA may be included in a higher GM index, the results may be prone to false positives; particularly in IgG-type MM, the results should thus be interpreted cautiously.
背景/目的：侵袭性肺曲霉病（IA）是血液系统疾病患者中常见的一种感染性疾病。IA的预防、早期检测及治疗策略的制定至关重要。欧洲癌症研究与治疗组织-侵袭性真菌感染协作组/美国国立过敏与传染病研究所真菌病研究组（EORTC/MSG）的真菌学标准中包含的用于IA诊断的血清半乳甘露聚糖抗原（GM）真菌学检测，因其高敏感性和特异性而被广泛应用。然而，假阳性结果令人担忧。
我们回顾性分析了2003年4月至2012年1月在我们科室临床实践中进行的所有GM检测。
在分析的330例病例和2155份样本中，540份（25%）呈阳性（≥0.5）。在基础疾病中，多发性骨髓瘤（MM）的阳性率最高，为61.3%。按类型划分，IgG、IgA、本周蛋白和IgD的阳性率分别为71.7%、33.3%、57.1%和34.6%。根据2008年EORTC/MSG标准，MM诊断时GM呈阳性的18例病例中有17例为假阳性。IgG和GM值无直接相关性。在确定的17例假阳性病例中，2例在抗骨髓瘤治疗期间发生了IA，且大多数病例治疗期间GM值未转阴。
尽管亚临床IA可能具有较高的GM指数，但结果可能容易出现假阳性；尤其是在IgG型MM中，因此对结果的解释应谨慎。
