Detection of galactomannan antigenemia by enzyme immunoassay for the diagnosis of invasive aspergillosis: Variables that affect performance
Detection of galactomannan antigenemia by enzyme immunoassay for the diagnosis of invasive aspergillosis: Variables that affect performance
复制标题
DOI：
10.1086/422009
复制
发表时间：
2004-08-01
影响因子：
6.4
通讯作者：
Walsh, TJ
中科院分区：
文献类型：
--
作者：
Marr, KA;Balajee, SA;Walsh, TJ
侵袭性曲霉病（IA）是血液或骨髓移植的常见并发症。以前的研究报道了半乳甘露聚糖曲霉酶免疫测定（GM EIA）可能是一种有用的IA诊断工具，但其敏感性是可变的。我们在67例患者的986份血清样本中检测了GM EIA的性能。结果表明，将阳性的指数截止值降低到0.5增加了其敏感性，而特异性的损失最小。低截止时间延长了临床诊断前检测阳性的时间。未接受预防性霉菌活性抗真菌药物治疗的患者敏感性最高（87.5%）。兔模型表明，循环抗原水平与组织真菌负荷相关。临床样品和兔模型对抗真菌治疗的可量化反应支持了该检测的发展，用于早期诊断和治疗监测。0.5的临界值作为早期诊断测试可能会有更好的表现。
Invasive aspergillosis (IA) is a frequent complication of blood or marrow transplantation. Previous studies have reported that the Aspergillus galactomannan enzyme immunoassay ( GM EIA) may be a useful diagnostic tool for IA, but its sensitivity is variable. We examined the performance of the GM EIA in 986 serum samples from 67 patients. Results demonstrated that decreasing the index cutoff for positivity to 0.5 increased its sensitivity, with minimal loss of specificity. The low cutoff increased the duration of test positivity before diagnosis by clinical means. Sensitivity was highest in patients who did not receive preventative mold-active antifungals (87.5%). A rabbit model demonstrated that the level of circulating antigen correlated with the tissue fungus burden. A quantifiable response to antifungal therapy in clinical samples and the rabbit model supports the development of this assay for early diagnosis and therapeutic monitoring. The 0.5 cutoff may allow for better performance as an early diagnostic test.