Aspergillus galactomannan testing in patients with long-term neutropenia:: implications for clinical management
Aspergillus galactomannan testing in patients with long-term neutropenia:: implications for clinical management
复制标题
DOI：
10.1093/annonc/mdm571
复制
发表时间：
2008-05-01
影响因子：
50.5
通讯作者：
Thiel, E.
中科院分区：
文献类型：
--
作者：
Penack, O.;Rempf, P.;Thiel, E.
我们对半乳甘露聚糖酶免疫测定 (GEI)（Platelia (TM) 曲霉 EIA，Bio-Rad）进行了一项前瞻性研究，用于诊断 200 名血液恶性肿瘤和严重中性粒细胞减少症患者的血清和支气管肺泡灌洗液 (BAL) 中的侵袭性曲霉病 (IA)。已证实和可能的 IA 发生率分别为 6% 和 5.5%。在发烧或肺炎患者中，单项阳性 GEI 检测结果（半乳甘露聚糖指数 >= 0.5）具有极好的特异性（100%）。发热时敏感度相对较低（40%），但发热6天后增加至94.7%。对于胸部 X 光或计算机断层扫描有浸润的患者 (n = 48)，与血清中的 GEI 检测相比，BAL 中的 GEI 检测具有良好的诊断准确性（敏感性 100% 与 71%）。我们的研究结果表明，对于 GEI 检测呈阳性的中性粒细胞减少症患者，应在发烧时立即开始抗真菌治疗。对于广谱抗生素耐药的发热患者（发热 6 天），GEI 检测的高诊断准确性使其成为有价值的诊断工具，并质疑在这种情况下无论诊断检测如何进行抗真菌治疗的常见策略。我们的数据还表明，BAL 中的 GEI 检测可有助于血液恶性肿瘤和肺部浸润患者的 IA 早期诊断。
We carried out a prospective study on galactomannan enzyme immuno assay ( GEI) ( Platelia (TM) Aspergillus EIA, Bio- Rad) testing for diagnosis of invasive aspergillosis ( IA) in serum and broncho- alveolar lavage ( BAL) in 200 patients with hematological malignancies and profound neutropenia. The incidence of proven and probable IA was 6% and 5.5%, respectively. In patients with fever or pneumonia, a single- positive GEI test result ( galactomannan index >= 0.5) had excellent specificity ( 100%). Sensitivity was relatively low ( 40%) at onset of fever, but increased to 94.7% after 6 days of fever. In patients with infiltrates in chest X- ray or computed tomography scan ( n = 48), GEI testing in BAL had a favorable diagnostic accuracy as compared with GEI testing in serum ( sensitivity100% versus 71%). Our findings indicate that antifungal therapy should be started immediately at onset of fever in neutropenic patients with positive GEI tests. In patients with fever refractory to broad- spectrum antibiotics ( 6 days of fever), the high diagnostic accuracy makes GEI testing a valuable diagnostic tool and questions the common strategy to carry out antifungal treatment irrespective of diagnostic testing in this situation. Our data also show that GEI testing in BAL can be useful for early diagnosis of IA in patients with hematological malignancies and pulmonary infiltrates.