PLASMA (1-]3)-BETA-D-GLUCAN MEASUREMENT IN DIAGNOSIS OF INVASIVE DEEP MYCOSIS AND FUNGAL FEBRILE EPISODES
PLASMA (1-]3)-BETA-D-GLUCAN MEASUREMENT IN DIAGNOSIS OF INVASIVE DEEP MYCOSIS AND FUNGAL FEBRILE EPISODES
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DOI：
10.1016/s0140-6736(95)91152-9
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发表时间：
1995-01-07
期刊：
影响因子：
168.9
通讯作者：
KAWAI, T
中科院分区：
文献类型：
--
作者：
OBAYASHI, T;YOSHIDA, M;KAWAI, T
(1-->3）-β-D-葡聚糖是一种特征性的真菌细胞壁成分。为了评估这种葡聚糖在筛选侵袭性真菌感染或真菌性发热事件中的临床实用性，我们通过G因子（一种对这种多糖极其敏感的鲎凝血酶）测量了202例发热事件中常规血培养时的血浆浓度。血浆截止值为20 pg/mL，41例明确的真菌感染（在微生物学或通过微生物学证实）中有37例具有59次非真菌性发热的阳性结果，或胶原蛋白疾病的浓度低于临界值（特异性100%）。在102例不明原因发热中，26例血浆葡聚糖浓度超过20 pg/mL。以非真菌感染102例为例，其阳性预测值为59%（37/63），阴性预测值为97%（135/139），有效率为85%（172/202）。如果有一个敏感的金标准可以区分真菌和非真菌感染，阳性预测值应该会提高。致病真菌包括念珠菌、曲霉菌、隐球菌和丝孢酵母菌。用G因子测定血浆（1->3）-β-D-葡聚糖是一种高度敏感和特异的检测侵袭性深部真菌病和真菌性发热的方法，对免疫功能低下的患者有很大益处。
(1-->3)-beta-D-glucan is a characteristic fungal cell-wall constituent. To assess the clinical usefulness of this glucan in screening for invasive fungal infection or fungal febrile episodes, we measured the plasma concentration at the time of routine blood culture in 202 febrile episodes by means of factor G, a horseshoe-crab coagulation enzyme that is extremely sensitive to this polysaccharide.With a plasma cut-off value of 20 pg/mL, 37 of 41 of definite fungal infections (confirmed at or by microbiology) had positive results of 59 episodes of non-fungal fever, or collagen diseases had concentrations below the cut-off value (specificity 100%). Of 102 episodes of fever of unknown origin, 26 had plasma glucan concentrations of more than 20 pg/mL. With those 102 cases taken as non-fungal infections, the positive predictive Value of the test was estimated as 59% (37/63), the negative predictive value as 97% (135/139), and the efficiency as 85% (172/202). The positive predictive Value should improve if there were a sensitive gold standard that could discriminate fungal from non-fungal infections. Causative fungi included candida, aspergillus, cryptococcus, and trichosporon.Determination of plasma (1-->3)-beta-D-glucan with factor G is a highly sensitive and specific test for invasive deep mycosis and fungal febrile episodes, and will substantially benefit immunocompromised patients.