Zhang Yeyang, Guo Pengle, He Yaozu, Zhang Qinzhi, Yang Longping, Ke Yingchun, Meng Yu, Xu Feilong, Tang Xiaopin, Li Linghua
Guangzhou Medical Research Institute of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, 510440, China; Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, 510440, China.
Guangzhou Medical Research Institute of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, 510440, China; Institute of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical Diseases University, Guangzhou, 510440, China.
J Mycol Med. 2025 Jun;35(2):101553. doi: 10.1016/j.mycmed.2025.101553. Epub 2025 Apr 29.
We evaluated Talaromyces marneffei mannoprotein (Mp1p) antigen in urine to create a practical, rapid diagnostic tool for early treatment and reduced mortality.
METHODOLOGY/PRINCIPAL FINDINGS: This prospective cross-sectional study assessed the sensitivity and specificity of Mp1p detection in urine samples from 215 AIDS patients at Guangzhou Eighth People's Hospital, enrolled between March 2022 and January 2023, using ELISA and fluorescence immunochromatography (FIC). In both the Talaromycosis and non-talaromycosis groups, most patients were male, comprising 82.5 % and 88.6 %, respectively. The median age was 42 years for the talaromycosis group and 48 years for the non-talaromycosis group. All patients were HIV-infected, with median CD4+ T cell counts of 47 cells/μL for talaromycosis and 187 cells/μL for non-talaromycosis. Among detection methods, ELISA showed the highest sensitivity (77.5 %, 95 % CI: 61.5-89.2 %) and specificity (97.1 %, 95 % CI: 93.5-99.1 %) for the Mp1p antigen in urine. The Positive Predictive Value (PPV), Negative Predictive Value (NPV), and kappa coefficient were 79.5 % (31/39), 94.9 % (167/176), and 0.739, respectively. The Area Under the Curve (AUC) accuracy for distinguishing patients with talaromycosis was 85.8 % (95 % CI, 76.9-94.9 %). The sensitivity, specificity, PPV, NPV, and kappa value of the Mp1p antigen (Ag) in urine following FIC were 67.5 % (95 % CI: 50.9-81.4 %), 94.9 % (95 % CI: 90.5-97.6 %), 75 % (27/36), 92.7 % (166/179), and 0.649, respectively. Combining urine Mp1p Ag ELISA with serum Mp1p Ag FIC achieved the highest specificity (96 %), PPV (82.1 %), and kappa value (0.767). In contrast, the urine Mp1p Ag ELISA and serum GM Ag pairing showed the highest sensitivity (92.5 %) and NPV (98.1 %).
Identification of the Mp1p antigen (Ag) in urine has been shown to be a reliable method for differentiating coinfections in AIDS patients, serving as a supplementary tool for early detection in clinical settings.
我们评估了尿液中的马尔尼菲篮状菌甘露糖蛋白（Mp1p）抗原，以创建一种实用、快速的诊断工具，用于早期治疗并降低死亡率。
方法/主要发现：这项前瞻性横断面研究评估了2022年3月至2023年1月期间在广州市第八人民医院招募的215例艾滋病患者尿液样本中Mp1p检测的敏感性和特异性，采用酶联免疫吸附测定（ELISA）和荧光免疫层析法（FIC）。在马尔尼菲篮状菌病组和非马尔尼菲篮状菌病组中，大多数患者为男性，分别占82.5%和88.6%。马尔尼菲篮状菌病组的中位年龄为42岁，非马尔尼菲篮状菌病组为48岁。所有患者均感染了艾滋病毒，马尔尼菲篮状菌病组的CD4+T细胞计数中位数为47个/μL，非马尔尼菲篮状菌病组为187个/μL。在检测方法中，ELISA对尿液中Mp1p抗原的敏感性最高（77.5%，95%CI：61.5 - 89.2%）和特异性最高（97.1%，95%CI：93.5 - 99.1%）。阳性预测值（PPV）、阴性预测值（NPV）和kappa系数分别为79.5%（31/39）、94.9%（167/176）和0.739。区分马尔尼菲篮状菌病患者的曲线下面积（AUC）准确性为85.8%（95%CI，76.9 - 94.9%）。FIC检测后尿液中Mp1p抗原（Ag）的敏感性、特异性、PPV、NPV和kappa值分别为67.5%（95%CI：50.9 - 81.4%）、94.9%（95%CI：90.5 - 97.6%）、75%（27/36）、92.7%（166/179）和0.649。尿液Mp1p Ag ELISA与血清Mp1p Ag FIC联合使用时特异性最高（96%）、PPV（82.1%）和kappa值（0.767）。相比之下，尿液Mp1p Ag ELISA与血清GM Ag配对时敏感性最高（92.5%）和NPV（98.1%）。
尿液中Mp1p抗原（Ag）的鉴定已被证明是区分艾滋病患者合并感染的可靠方法，可作为临床环境中早期检测的辅助工具。
