Utility of Galactomannan Enzyme Immunoassay and (1,3) β-D-Glucan in Diagnosis of Invasive Fungal Infections: Low Sensitivity for Aspergillus fumigatus Infection in Hematologic Malignancy Patients
Utility of Galactomannan Enzyme Immunoassay and (1,3) β-D-Glucan in Diagnosis of Invasive Fungal Infections: Low Sensitivity for Aspergillus fumigatus Infection in Hematologic Malignancy Patients
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DOI：
10.1128/jcm.00506-08
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发表时间：
2009-01-01
影响因子：
9.4
通讯作者：
Raad, I.
中科院分区：
文献类型：
--
作者：
Hachem, R. Y.;Kontoyiannis, D. P.;Raad, I.
以前的研究报道了半乳甘露聚糖（GM）酶免疫测定和1,3 β -葡聚糖（BG）测定可能是有用的诊断工具，但它们的敏感性是可变的。我们比较了两种测试的性能。2002年10月至2005年5月期间，82名患者进行了为期12周的前瞻性监测。对侵袭性曲霉病（IA）患者、其他霉菌感染（镰刀菌、梭孢菌、合胞菌等）患者、念珠菌病患者和对照组患者共检测414份样本，BG检测409份样本。第1周采集两次血样，每隔一周采集一次，共12周。侵袭性真菌感染组的患者具有相似的危险因素。非烟曲霉引起的IA患者的GM检测灵敏度明显高于烟曲霉引起的IA患者（49%对13%，P < 0.0001）或其他霉菌感染的IA患者（49%对6%，P < 0.0001）。然而，无论感染病原体如何，BG检测的敏感性范围（47%至64%）和特异性（88%）在所有接受检测的患者中具有可比性。基于转基因的诊断性能似乎更好地检测非烟曲霉种。诊断标志物BG在检测血液学恶性肿瘤患者的IA和其他霉菌感染方面具有比GM更高的敏感性。
Previous studies have reported that galactomannan (GM) enzyme immunoassay and 1,3 beta-glucan (BG) assay may be useful diagnostic tools, but their sensitivities are variable. We compared the performances of both tests. Between October 2002 and May 2005, 82 patients were prospectively monitored for 12 weeks. A total of 414 samples were tested by GM assay and 409 samples were tested by BG assay for the following four groups of patients: those with invasive aspergillosis (IA), those with other mold infections (Fusarium, scedosporium, zygomycosis, etc.), those with candidemia, and control patients. Blood samples were obtained twice on week 1 and once every other week for a total of 12 weeks. Patients in the invasive fungal infection groups had comparable risk factors. The sensitivity of the GM test was significantly higher for patients with IA due to non-fumigatus Aspergillus species than for patients with IA due to Aspergillus fumigatus (49% versus 13%; P < 0.0001) or with other mold infections (49% versus 6%; P < 0.0001). However, the sensitivity range (47% to 64%) and specificity (88%) of the BG assay were comparable among all patients tested, regardless of the infecting pathogen. The performance of GM-based diagnosis appears to be better for detecting non-fumigatus Aspergillus species. The diagnostic marker BG was shown to have a higher sensitivity than that of GM in detecting IA and other mold infections in hematologic malignancy patients.