Reappraisal of the serum (1→3)-β-D-glucan assay for the diagnosis of invasive fungal infections -: A study based on autopsy cases from 6 years
Reappraisal of the serum (1→3)-β-D-glucan assay for the diagnosis of invasive fungal infections -: A study based on autopsy cases from 6 years
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DOI：
10.1086/588295
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发表时间：
2008-06-15
影响因子：
11.8
通讯作者：
Funata, Nobuaki
中科院分区：
文献类型：
--
作者：
Obayashi, Taminori;Negishi, Kumiko;Funata, Nobuaki
背景侵袭性真菌感染的患病率正在增加。一个有效的诊断测试是必要的，以识别和治疗他们成功。我们回顾了2000年1月至2004年12月期间在我院的所有尸检记录，以确定是否存在侵袭性真菌感染。仅使用患者在死亡前2周内接受过真菌感染检测的病例，检查血清（1 -> 3）-β-D-葡聚糖（β-葡聚糖）检测的诊断效力。在456例尸检中，54例（11.8%）涉及侵袭性真菌感染。白血病是最常见的基础疾病（52%的侵袭性真菌感染病例），曲霉菌是最常见的病原体（70%）。在54例侵袭性真菌感染患者中，41例在死亡前2周内进行了β-葡聚糖检测，63例无侵袭性真菌感染患者也是如此; 54例侵袭性真菌感染患者中有48例进行了血培养。β-葡聚糖试验检测侵袭性真菌感染的灵敏度和特异性分别为95.1%和85.7%，临界值为30 pg/mL;分别为85.4%和95.2%，临界值为60 pg/mL;分别为78.0%和98.4%，临界值为80 pg/mL。血培养的敏感性为8.3%。在患病率为11.8%的情况下，β-葡聚糖检测的阳性和阴性预测值分别为47.1%和99.2%，临界值为30 pg/mL;分别为70.4%和98.0%，临界值为60 pg/mL;分别为86.7%和97.1%，临界值为80 pg/mL。在为期6年的研究期间，在21名真菌阳性血培养患者中，在2周内进行β-葡聚糖检测之前或之后，4名患者的β-葡聚糖检测结果为阴性（β-葡聚糖水平，60 pg/mL）;培养结果与β-葡聚糖检测结果之间的一致性为81.0%。与一般观点相反，6例隐球菌血症中有5例与高血清β-葡聚糖水平有关。β-葡聚糖试验是侵袭性真菌感染的有效诊断工具。
Background. The prevalence of invasive fungal infection is increasing. An effective diagnostic test is required to identify and treat them successfully.Methods. All autopsy records at our hospital for the period from January 2000 through December 2004 were reviewed for cases of invasive fungal infection. The diagnostic efficacy of a serum (1 -> 3)-beta-D-glucan (beta-glucan) assay was examined using only those cases in which patients had been tested for fungal infection within 2 weeks before death.Results. Of 456 autopsies, 54 (11.8%) involved cases of invasive fungal infection. Leukemias were the most frequent underlying disease (in 52% of cases of invasive fungal infection), and Aspergillus species was the most frequent pathogen detected (in 70%). Of the 54 patients with invasive fungal infection, 41 had beta-glucan testing performed within 2 weeks before death, as did 63 patients without invasive fungal infection; 48 of 54 patients with invasive fungal infection had a blood culture performed. The sensitivity and specificity of the beta-glucan test for the detection of invasive fungal infection were 95.1% and 85.7%, respectively, with a cutoff value of 30 pg/mL; 85.4% and 95.2%, respectively, with a cutoff value of 60 pg/mL; and 78.0% and 98.4%, respectively, with a cutoff value of 80 pg/mL. The sensitivity of blood culture testing was 8.3%. With a prevalence of 11.8%, the positive and negative predictive values for the beta-glucan test were 47.1% and 99.2%, respectively, with a cutoff of 30 pg/mL; 70.4% and 98.0%, respectively, with a cutoff of 60 pg/mL; and 86.7% and 97.1%, respectively, with a cutoff of 80 pg/mL. During the 6-year period studied, of 21 patients with fungus-positive blood cultures that were preceded or followed by a beta-glucan test within 2 weeks, 4 had negative beta-glucan test results (beta-glucan level, 60 pg/mL); the concordance between culture results and beta-glucan test results was 81.0%. Contrary to the general belief, 5 of 6 cases of cryptococcemia were associated with high serum beta-glucan levels.Conclusion. The beta-glucan test is an effective diagnostic tool for invasive fungal infection.