Contribution of (1→3)-β-D-glucan chromogenic assay to diagnosis and therapeutic monitoring of invasive aspergillosis in neutropenic adult patients:: a comparison with serial screening for circulating galactomannan
Contribution of (1→3)-β-D-glucan chromogenic assay to diagnosis and therapeutic monitoring of invasive aspergillosis in neutropenic adult patients:: a comparison with serial screening for circulating galactomannan
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DOI：
10.1128/jcm.43.1.299-305.2005
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发表时间：
2005-01-01
影响因子：
9.4
通讯作者：
Del Palacio, A
中科院分区：
文献类型：
--
作者：
Pazos, C;Pontón, J;Del Palacio, A
对40例中性粒细胞减少的成人侵袭性曲霉病(IA)高危患者进行了两种非侵入性诊断试验：(1->；3)-β-D-葡聚糖(BG)(GLucatell)和半乳甘露聚糖(GM)(Platelia Aspergilla)，每周两次，共40个疗程(每个患者一次就诊)，用于诊断侵袭性曲霉病。诊断出5例确诊的IA病例、3例疑似IA病例和3例疑似IA病例。确诊的IA患者中100%检测到BG和GM诊断水平，疑似IA患者中66%检测到BG和GM诊断水平。两种标志物在IA患者中的动态变化相似。GM和BG的敏感性、特异性、阳性预测值和阴性预测值相同，分别为87.5%、89.6%、70%和96.3%。两种试验的假阳性反应率均为10.3%，但每次试验中出现假阳性的患者不同。在大多数患者中，这两项检测都预测到了临床诊断、计算机断层扫描异常和开始抗真菌治疗，但BG倾向于比GM更早转为阳性。在不影响灵敏度和阴性预测值的情况下，两种测试的组合提高了每个单独测试的特异度(到100%)和阳性预测值(到100%)。总而言之，BG和GM检测是诊断高危血液病患者IA的有用测试，但两种测试结合起来对识别每项测试的假阳性反应非常有用。
Two noninvasive diagnostic tests, (1-->3)-beta-D-glucan (BG) (Glucatell) and galactomannan (GM) (Platelia Aspergillus), were used retrospectively in a twice-weekly screening for the diagnosis of invasive aspergillosis (IA) in 40 treatment episodes (one hospital visit per patient) in 40 neutropenic adult patients at high risk for IA. Five proven IA cases, three probable IA cases, and three possible IA cases were diagnosed. Diagnostic levels of both BG and GM were detected in 100% of patients with proven IA cases and in 66% of patients with probable IA cases. The kinetics of both markers in patients with IA were similar. The sensitivity, specificity, and positive and negative predictive values for GM and BG were identical, namely, 87.5, 89.6, 70, and 96.3%, respectively. False-positive reactions occurred at a rate of 10.3% in both tests, but the patients showing false-positive results were different in each test. Both tests anticipated the clinical diagnosis, computed tomography abnormalities, and the initiation of antifungal therapy in most patients, but BG tended to become positive earlier than GM. A combination of the two tests improved the specificity (to 100%) and positive predictive value (to 100%) of each individual test without affecting the sensitivity and negative predictive values. In conclusion, BG and GM detection are useful tests for the diagnosis of IA in high-risk hematological patients, but a combination of the two tests was very useful to identify false-positive reactions by each test.