Application of Mass Spectrometry Technology to Early Diagnosis of Invasive Fungal Infections.
Application of Mass Spectrometry Technology to Early Diagnosis of Invasive Fungal Infections.
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DOI：
10.1128/jcm.01655-16
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发表时间：
2016-11
影响因子：
9.4
通讯作者：
Poulain D
中科院分区：
文献类型：
--
作者：
Mery A;Sendid B;François N;Cornu M;Poissy J;Guerardel Y;Poulain D
我们最近开发了一种基于检测侵袭性念珠菌病（IC）患者血清双糖（MS-DS）的质谱（MS）程序。在这里，我们比较了性能的MS-DS诊断IC，侵袭性曲霉菌病（IA），毛霉菌病（MM）与市售抗原检测试验。这项回顾性研究包括48例患者（23例IC患者[74份血清样本]、15例IA患者[40份血清样本]和10例MM患者[15份血清样本]）和49例适当对照（102份血清样本）。MS-DS、甘露聚糖（Mnn）、半乳甘露聚糖（GM）和（1，3）-β-d-葡聚糖（BDG）分别通过基质辅助激光解吸电离飞行时间（MALDI-TOF）MS、Platelia和Fungitell测定法检测。对于IC，MS-DS指数、BDG检测和Mnn检测的灵敏度和特异性分别为每个血清样本62%和84%、82%和60%、33%和94%以及每个患者83%和69%、96%和31%、39%和86%。对于IA，与BDG和GM检测相比，每个血清样本的相应值分别为83%和81%、62%和95%、62%和100%，每个患者的相应值分别为93%和76%、87%和90%、93%和100%。9/10例MM患者的MS-DS结果为阳性。MS-DS对IC（血培养前73%阳性）、IA（6例GM检测前阳性）和MM（阳性主要发生在诊断日期之前）患者进行了早期诊断。对于IC，持续MS-DS与预后不良相关。不同的生物标志物很少被同时检测到，这表明释放和清除的动力学不同。就执行机构而言，MS-DS比商业发展风险监测更好地补充了全球机制的监测。MS-DS检测侵袭性真菌感染期间循环的泛真菌分子。MS-DS的性能与目前推荐用于监测高危患者的生物学试验相比毫不逊色。需要在多中心研究中进一步验证该试验。
We recently developed a mass spectrometry (MS) procedure based on the detection of a serum disaccharide (MS-DS) in patients with invasive candidiasis (IC). Here, we compare the performance of MS-DS for the diagnosis of IC, invasive aspergillosis (IA), and mucormycosis (MM) with those of commercially available antigen detection tests. This retrospective study included 48 patients (23 IC patients [74 serum samples], 15 IA patients [40 serum samples], and 10 MM patients [15 serum samples]) and 49 appropriate controls (102 serum samples). MS-DS, mannan (Mnn), galactomannan (GM), and (1,3)-β-d-glucan (BDG) were detected by matrix-assisted laser desorption ionization–time of flight (MALDI-TOF) MS, Platelia, and Fungitell assays, respectively. For IC, the sensitivity and specificity of the MS-DS index, BDG detection, and Mnn detection were 62% and 84%, 82% and 60%, and 33% and 94% per serum sample and 83% and 69%, 96% and 31%, and 39% and 86% per patient, respectively. For IA, the corresponding values in comparison to BDG and GM detection were 83% and 81%, 62% and 95%, and 62% and 100% per serum sample and 93% and 76%, 87% and 90%, and 93% and 100% per patient, respectively. Nine of the 10 MM patients had a positive MS-DS result. MS-DS gave an early diagnosis in IC (73% positivity before blood culture), IA (positive before GM detection in six patients), and MM (positivity mainly preceded the date of diagnosis) patients. For IC, persisting MS-DS was associated with a poor prognosis. The different biomarkers were rarely detected simultaneously, suggesting different kinetics of release and clearance. For IA, MS-DS provided better complementation to GM monitoring than BDG monitoring. MS-DS detects panfungal molecules circulating during invasive fungal infections. The performance of MS-DS compared favorably with those of biological tests currently recommended for monitoring at-risk patients. Further validation of this test in multicenter studies is required.