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在恶性血液病、异体干细胞移植或实体器官移植患者等高危人群中,侵袭性曲霉病(IA)的早期诊断很重要,因为未能诊断IA或诊断延迟将导致死亡率增高。IA传统检测方法敏感性和特异性都很低,以及IA患者数量的不断增加,导致新方法的发展。这些方法包括抗原的检测如检测血清中的半乳甘露聚糖(GM)和真菌-β1,3-葡聚糖等,以及不同的分子方法(PCR法)。GM检测已商业化,但仍需大规模评价,尤其是在儿童。已发展了不同的PCR方法,针对不同的基因区域,包括各种扩增子的检测方法。这些分子方法就敏感性和特异性而言有很高的潜力,但可行性变化很大,到目前为止还没有标准化。总之,新的非培养诊断法的优点是非侵入性、简单、快速、敏感。因此,它们可能有助于IA的早期诊断,减少经验性抗真菌治疗并监测抗真菌治疗疗效。
Early diagnosis of invasive aspergillosis (IA) is important in high-risk populations such as patients with hematologic malignancies, allogeneic stem cell transplantation or solid organ transplantation because failure to diagnose IA or delay in diagnosis leads to increased mortality. The sensitivity and specificity of IA traditional detection methods are low, and the number of patients with IA continues to increase, leading to the development of new methods. These methods include the detection of antigens such as galactomannan (GM) and fungal-β1,3-glucan in serum, as well as different molecular methods (PCR). GM testing has been commercialized but still requires large-scale evaluation, especially in children. Different PCR methods have been developed for different gene regions, including detection methods for various amplicons. These molecular approaches have great potential in terms of sensitivity and specificity, but the viability has changed dramatically and so far has not been standardized. In summary, the advantages of the new non-cultured diagnosis are non-invasive, simple, rapid and sensitive. Therefore, they may contribute to the early diagnosis of IA, reduce the experience of antifungal therapy and monitor the antifungal therapy efficacy.