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目的:用酶联免疫吸附法(ELISA)检测患者外周血曲霉菌半乳甘露聚糖(GM)抗原筛查侵袭性肺曲霉菌病(IPA)的价值,探索合适的判断标准。方法:采用ELISA方法检测临床怀疑曲霉菌感染的55例患者共计65份血清中的GM,并根据欧洲癌症研究治疗组织及真菌研究组(EOR TC/MSG)的标准将研究对象分类,按照不同的阳性判断标准分别评价ELISA法检测GM诊断IPA的价值。结果:55例患者中临床诊断4例,拟诊9例,临床排除42例。以cut-off值>1为阳性判断标准,8例GM实验阳性,其中临床诊断3例,拟诊5例,灵敏度分别为75%(3/4),55.56%(5/9);临床排除病例中无GM实验阳性,特异性度100%(42/42)。以cut-off值>0.5为阳性判断标准(包括可疑阳性),17例GM实验阳性,其中临床诊断3例,拟诊8例,灵敏度分别为75%(3/4),88.89%(8/9);临床排除病例中6例阳性,特异性度为83.33%(36/42)。结论:血清GM抗原检测可用于早期诊断IPA,未来可能成为IPA的常规筛查手段。
Objective: To detect the value of Aspergillus oryzae galactomannan (GM) antigen screening for invasive pulmonary aspergillosis (IPA) by enzyme-linked immunosorbent assay (ELISA), and to explore suitable criteria. METHODS: A total of 65 serum GMs were detected in 55 patients with clinically suspected Aspergillus infection by ELISA. The subjects were classified according to the criteria of the European Organization for the Study of Cancer Therapy and Fungi (EOR TC / MSG) Positive criteria were evaluated by ELISA to detect the value of GM diagnosis of IPA. Results: Among 55 patients, 4 were diagnosed clinically, 9 were diagnosed clinically and 42 were clinically excluded. The cut-off value> 1 was positive, and 8 cases of GM test were positive, of which 3 cases were clinically diagnosed and 5 cases were diagnosed. The sensitivity was 75% (3/4) and 55.56% (5/9) respectively. No GM test positive cases, the specificity of 100% (42/42). Seventeen GM tests were positive with a cut-off value> 0.5 as a positive criterion (including suspicious positives), of which 3 were clinically diagnosed and 8 were diagnosed. The sensitivity was 75% (3/4) and 88.89% (8 / 9). Of the 6 cases that were clinically excluded, the positive rate was 83.33% (36/42). Conclusion: The detection of serum GM antigen can be used to diagnose IPA in the early stage and may become the routine screening method of IPA in the future.