The (1,3)β-D-Glucan Test as an Aid to Early Diagnosis of Invasive Fungal Infections following Lung Transplantation
The (1,3)β-D-Glucan Test as an Aid to Early Diagnosis of Invasive Fungal Infections following Lung Transplantation
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DOI：
10.1128/jcm.01183-10
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发表时间：
2010-11-01
影响因子：
9.4
通讯作者：
Reller, L. Barth
中科院分区：
文献类型：
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作者：
Alexander, Barbara D.;Smith, P. Brian;Reller, L. Barth
血清中 (1,3)β-D-葡聚糖 (BG) 检测的 Fungitell 测定法已在侵袭性真菌感染 (IFI) 患者和健康对照中进行了评估，并用于癌症患者 IFI 的早期诊断。我们评估了 BG 检测在肺移植受者中检测 IFI 的情况。前瞻性地从杜克医院接受肺移植的患者身上收集了连续血清样本。根据修订后的欧洲癌症研究和治疗组织/真菌病研究组标准对真菌感染进行分类。生成受试者工作特征（ROC）曲线；通过线性回归分析调查假阳性和假阴性测试的可能原因。测试了来自 59 名无 IFI 受试者的 756 份血清样本和来自 14 名已证实或可能患有 IFI 患者的 41 份样本。 ROC曲线下面积为0.69。基于 60 pg/ml 阳性截止值，每位患者的敏感性、特异性、阳性预测值 (PPV) 和阴性预测值 (NPV) 分别为 64%、9%、14% 和 50%；每次测试的估计值分别为 71%、59%、9% 和 97%。大多数 (92%) 未诊断为 IFI 的患者至少有一项 BG 水平≥ 60 pg/ml，90% 的患者至少有一项 BG 水平≥ 80 pg/ml。霉菌的呼吸道定植和血液透析显着影响平均血糖水平。总之，BG 测试的准确性很有限，并且其作为 IFI 早期诊断工具在肺移植人群中的效用值得怀疑。尽管 BG 测试的 NPV 较高，但较低的 PPV 限制了其作为 IFI 早期诊断筛查工具的实用性。
The Fungitell assay for (1,3)beta-D-glucan (BG) detection in serum has been evaluated in patients with invasive fungal infections (IFIs) and healthy controls and for the early diagnosis of IFI in cancer patients. We evaluated the BG assay for the detection of IFI in lung transplant recipients. Serial serum samples were prospectively collected from patients undergoing lung transplants at Duke Hospital. Fungal infections were classified according to revised European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. A receiver operator characteristic (ROC) curve was generated; possible causes for false-positive and false-negative tests were investigated by linear regression analysis. Seven hundred fifty-six serum specimens from 59 subjects without IFI and 41 specimens from 14 patients with proven or probable IFI were tested. The area under the ROC curve was 0.69. Based on a 60-pg/ml positive cutoff, per-patient sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 64%, 9%, 14%, and 50%, respectively; per-test estimates were 71%, 59%, 9%, and 97%, respectively. The majority (92%) of patients not diagnosed with an IFI had at least one BG level of >= 60 pg/ml, and 90% had at least one BG level of >= 80 pg/ml. Respiratory colonization with mold and hemodialysis significantly affected mean BG levels. In conclusion, the accuracy of the BG test is marginal and its utility as a tool for the early diagnosis of IFI is questionable in the lung transplant population. Although the NPV of the BG test is high, the low PPV limits its utility as a screening tool for early diagnosis of IFI.