念珠菌特异性IgM和IgG抗体在肺念珠菌病中的诊断价值
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摘要
目的:评价念珠菌特异性IgM和IgG抗体在肺念珠菌病中的诊断价值。方法:入选2017-09-01～2018-03-31住院患者76例,其中临床诊断肺念珠菌病患者8例、拟诊诊断肺念珠菌病患者13例、非念珠菌病患者55例(曲霉菌病患者12例、非真菌病患者28例、未确定病原菌患者15例);用胶体金法念珠菌特异性IgM和IgG抗体检测患者血液标本,与血清G实验和肺泡灌洗液(BALF)G实验比较,分析IgM和IgG抗体检测在诊断肺念珠菌病中的价值。结果:76例患者全部行IgM和IgG抗体检测,IgM抗体检测阳性33例,IgG抗体检测阳性22例;38例患者行血清G实验检测,阳性1例;35例患者行BALF G实验检测,阳性15例。检测灵敏度、特异度和Youden指数,IgM抗体检测分别为100.0%、64.2%和0.642,IgG抗体检测分别为87.5%、77.9%和0.654,血清G实验分别为0%、97.1%和-0.029,BALF G实验分别为83.3%、65.4%和0.487。结论:IgM抗体检测诊断肺念珠菌病的灵敏度高,可作为高危患者的筛查指标;IgG抗体检测灵敏度和特异度均较高,可作为诊断肺念珠菌病的指标。
Objective:To evaluate the efficiency of candidiasis-specific IgM and IgG antibodies in diagnosing patients with pulmonary candidiasis.Methods:Seventy-six patients hospitalizing in department of respiratory and critical care medicine from September 1, 2017 to March 31, 2018 were included: 8 patients with probable of pulmonary candidiasis, 13 patients with possible of pulmonary candidiasis and 55 patients with non-pulmonary candidiasis(12 patients with aspergillosis, 28 patients with non-fungal disease and 15 patients with non-exact pathogen).The blood samples of patients were detected by colloidal gold method Candida specific IgM and IgG antibodies,and the value of IgM and IgG antibody detection in the diagnosis of pulmonary candidiasis was analyzed compared with serum G test and BALF G test.Results:In the specific IgM and IgG antibody group, 33 patients were positive with IgM, and 22 patients were positive with IgG. In the serum G test group, only 1 patient was positive. In the BALF G test group, 15 patients were positive. In the specific IgM and IgG antibody group, the positive rate of patients with clinical diagnosed pulmonary candidiasis was much higher than positive rate of patients with nonIgM group, the sensitivity was 100.00%group, the sensitivity was 87.5%, the specificity was 77.9% and Youden index was 0.654. In the serum G test group, the sensitivity was 0%group, the sensitivity was 83.3%, the specificity was 65.4% and Youden index was 0.487.Conclusion:The sensitivity of specific IgM antibody method was higher in diagnosing patients with pulmonary candidiasis, and it could be the screening indicator for the high risk patients. While the sensitivity and specificity of IgG antibody method was higher in diagnosing patients with pulmonary candidiasis, and it could be the diagnostic indicator for patients with pulmonary candidiasis.
Objective:To evaluate the efficiency of candidiasis-specific IgM and IgG antibodies in diagnosing patients with pulmonary candidiasis.Methods:Seventy-six patients hospitalizing in department of respiratory and critical care medicine from September 1, 2017 to March 31, 2018 were included: 8 patients with probable of pulmonary candidiasis, 13 patients with possible of pulmonary candidiasis and 55 patients with non-pulmonary candidiasis(12 patients with aspergillosis, 28 patients with non-fungal disease and 15 patients with non-exact pathogen).The blood samples of patients were detected by colloidal gold method Candida specific IgM and IgG antibodies,and the value of IgM and IgG antibody detection in the diagnosis of pulmonary candidiasis was analyzed compared with serum G test and BALF G test.Results:In the specific IgM and IgG antibody group, 33 patients were positive with IgM, and 22 patients were positive with IgG. In the serum G test group, only 1 patient was positive. In the BALF G test group, 15 patients were positive. In the specific IgM and IgG antibody group, the positive rate of patients with clinical diagnosed pulmonary candidiasis was much higher than positive rate of patients with nonIgM group, the sensitivity was 100.00%group, the sensitivity was 87.5%, the specificity was 77.9% and Youden index was 0.654. In the serum G test group, the sensitivity was 0%group, the sensitivity was 83.3%, the specificity was 65.4% and Youden index was 0.487.Conclusion:The sensitivity of specific IgM antibody method was higher in diagnosing patients with pulmonary candidiasis, and it could be the screening indicator for the high risk patients. While the sensitivity and specificity of IgG antibody method was higher in diagnosing patients with pulmonary candidiasis, and it could be the diagnostic indicator for patients with pulmonary candidiasis.
引文
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[11]中华医学会呼吸病学分会感染血组,中华结核和呼吸杂志编辑委员会.肺真菌病诊断和治疗专家共识[J].中华结核和呼吸杂志,2007,30(11):821-834.
[12]Chapman B,Slavin M,Marriott D,et al.Changing epidemiology of candidaemia in Australia[J].J Antimicrob Chemother,2017,72(4):1103-1108.
[13]TrouvéC,Blot S,Hayette M P,et al.Epidemiology and reporting of candidaemia in Belgium:a multi-centre study[J].Eur J Clin Microbiol Infect Dis,2017,36(4):649-655.
[14]Tortorano A M,Peman J,Bernhardt H,et al.Epidemiology of candidaemia in Europe:results of 28-month European Confederation of Medical Mycology(ECMM)hospital-based surveillance study[J].Eur J Clin Microbiol Infect Dis,2004,23(4):317-322.
[15]Su K C,Chou K T,Hsiao Y H,et al.Measuring(1,3)-β-D-glucan in tracheal aspirate,bronchoalveolar lavage fluid,and serum for detection of suspected Candida pneumonia in immunocompromised and critically ill patients:a prospective observational study[J].BMCInfect Dis,2017,17(1):252.
[2]Wisplinghoff H,Bischoff T,Tallent S M,et al.Nosocomial bloodstream infections in US hospitals:analysis of 24,179 cases from a prospective nationwide surveillance study[J].Clin Infect Dis,2004,39(3):309-317.
[3]刘又宁,佘丹阳,孙铁英,等.中国1998年至2007年临床确诊的肺真菌病患者的多中心回顾性调查[J].中华结核和呼吸杂志,2011,34(2):86-90.
[4]Bassetti M,Righi E,Montravers P,et al.What has changed in the treatment of invasive candidiasis?Alook at the past 10 years and ahead[J].J Antimicrob Chemother,2018,73(suppl 1):i14-i25.
[5]Kollef M,Micek S,Hampton N,et al.Septic shock attributed to Candida infection:importance of empiric therapy and source control[J].Clin Infect Dis,2012,54(12):1739-1746.
[6]Pappas P G,Kauffman C A,Andes D R,et al.Clinical practice guideline for the management of candidiasis:2016 update by the Infectious Diseases Society of America[J].Clin Infect Dis,2016,62(4):e1-50.
[7]Kumar A,Ellis P,Arabi Y,et al.Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock[J].Chest,2009,136(5):1237-1248.
[8]Clancy C J,Nguyen M H.Finding the"missing 50%"of invasive candidiasis:how nonculture diagnostics will improve understanding of disease spectrum and transform patient care[J].Clin Infect Dis,2013,56(9):1284-1292.
[9]Ullmann A J,Cornely O A,Donnelly J P,et al.ESCMIDguideline for the diagnosis and management of Candida diseases 2012:developing European guidelines in clinical microbiology and infectious diseases[J].Clin Microbiol Infect,2012,18(Suppl 7):1-8.
[10]Syed M A,Bokhari S H.Gold nanoparticle based microbial detection and identification[J].J Biomed Nanotechnol,2011,7(2):229-237.
[11]中华医学会呼吸病学分会感染血组,中华结核和呼吸杂志编辑委员会.肺真菌病诊断和治疗专家共识[J].中华结核和呼吸杂志,2007,30(11):821-834.
[12]Chapman B,Slavin M,Marriott D,et al.Changing epidemiology of candidaemia in Australia[J].J Antimicrob Chemother,2017,72(4):1103-1108.
[13]TrouvéC,Blot S,Hayette M P,et al.Epidemiology and reporting of candidaemia in Belgium:a multi-centre study[J].Eur J Clin Microbiol Infect Dis,2017,36(4):649-655.
[14]Tortorano A M,Peman J,Bernhardt H,et al.Epidemiology of candidaemia in Europe:results of 28-month European Confederation of Medical Mycology(ECMM)hospital-based surveillance study[J].Eur J Clin Microbiol Infect Dis,2004,23(4):317-322.
[15]Su K C,Chou K T,Hsiao Y H,et al.Measuring(1,3)-β-D-glucan in tracheal aspirate,bronchoalveolar lavage fluid,and serum for detection of suspected Candida pneumonia in immunocompromised and critically ill patients:a prospective observational study[J].BMCInfect Dis,2017,17(1):252.