抗烯醇化酶抗体与(1-3)-β-D-葡聚糖检测诊断侵袭性念珠菌病的临床比较

中国真菌学杂志　 2014, Vol. 9 　Issue (5): 272-274,271.

抗烯醇化酶抗体与(1-3)-β-D-葡聚糖检测诊断侵袭性念珠菌病的临床比较

廖红, 李芳秋, 张国勇, 李伟, 韩丹丹, 刘倩

南京军区南京总医院解放军临床检验医学研究所, 南京 210002

收稿日期:2014-05-20 出版日期:2014-10-28 发布日期:2014-10-28
通讯作者: 李芳秋, E-mail:njlifq@163.com E-mail:njlifq@163.com
作者简介:廖红, 男 (汉族), 硕士研究生在读.E-mail:liaohong@163.com
基金资助:
国家自然科学基金(81302536);南京军区医学科技创新重点课题(10Z027);江苏省科技支撑计划-社会发展项目(BE2009673)

Comparative diagnostic values of anti-enolase assay and the (1,3)-β-D-glucan assay in early invasive candidiasis

LIAO Hong, LI Fang-qiu, ZHANG Guo-yong, LI Wei, HAN Dan-dan, LIU Qian

Institute of Medical Laboratory Sciences of PLA, Nanjing General Hospital of Nanjing Military Command, PLA, Nanjing 210002, China

Received:2014-05-20 Online:2014-10-28 Published:2014-10-28

摘要/Abstract

摘要： 目的比较抗烯醇化酶抗体 (抗-Eno)检测与 (1-3)-β-D-葡聚糖 (BG)检测对侵袭性念珠菌病 (invasive candidiasis,IC)的诊断价值.方法留取临床为诊断IC而送检BG测定的患者血样,用ELISA法测定抗-Eno抗体,以真菌培养结果为基础,分析比较两种血清学方法诊断IC的效能.结果 210例患者为研究对象.15例患者经念珠菌培养确诊IC,确诊感染率7.1%;BG阳性54例,阳性率为25.7%;抗-Eno阳性33例,检出阳性率为15.7%.抗-Eno和G试验诊断IC感染的敏感性、特异性、阳性预测值、阴性预测值分别为46.7%、86.7%、21.2%、95.5%和33.3%、74.9%、9.3%、93.6%.两种血清学方法联合检测,敏感性提高至66.7%.结论抗-Eno对IC的诊断性能优于G试验;联合两种血清学方法,能有效提高敏感性.

关键词: 侵袭性念珠菌病, (1-3)-β-D-葡聚糖, 抗-Eno抗体

Abstract: Objectives To compare the anti-enolase (anti-Eno) assay with traditional (1,3)-β-D-glucan (BG) assay for the early diagnosis of invasive candidiasis (IC).Methods Blood samples collected from patients of suspected IC were analyzed with both anti-Eno and BG detection. Diagnostic values were compared based upon the results of fungal culture.Results A total of 210 patients were enrolled into this study. Fifteen patients (7.1%) were diagnosed as definitive IC by fungal culture. Positive results were obtained in 54 (25.7%) and 33 (15.7%) patients by BG and anti-Eno assay, respectively. The sensitivity, specificity, positive predictive value and negative predictive value were 46.7%, 86.7%, 21.2% and 95.5% in anti-Eno assay while 33.3%, 74.9%, 9.3% and 93.6% in (1,3)-β-D-glucan assay. The sensitivity for IC diagnosis was enhanced to 66.7% upon the combination of anti-Eno and (1,3)-β-D-glucan assay.Conclusion Anti-Eno assay is superior to (1,3)-β-D-glucan assay in the diagnosis of early IC. Combining these two assays can improve the sensitivity of IC diagnosis.

Key words: invasive candidiasis, (1,3)-β-D-glucan, anti-enolase

中图分类号:

R379.4

廖红, 李芳秋, 张国勇, 李伟, 韩丹丹, 刘倩. 抗烯醇化酶抗体与(1-3)-β-D-葡聚糖检测诊断侵袭性念珠菌病的临床比较[J]. 中国真菌学杂志, 2014, 9(5): 272-274,271.

LIAO Hong, LI Fang-qiu, ZHANG Guo-yong, LI Wei, HAN Dan-dan, LIU Qian. Comparative diagnostic values of anti-enolase assay and the (1,3)-β-D-glucan assay in early invasive candidiasis[J]. Chinese Journal of Mycology, 2014, 9(5): 272-274,271.

参考文献

[1] Ma CF, Li FQ, Shi LN, et al. Surveillance study of species distribution, antifungal susceptibility and mortality of nosocomial candidemia in a tertiary care hospital in China [J]. BMC Infect Dis, 2013, 13:337.
[2] Bassetti M, Taramasso L, Nicco E, et al. Epidemiology, species distribution, antifungal susceptibility and outcome of nosocomial candidemia in a tertiary care hospital in Italy [J]. PLoS One, 2011, 6(9): e24198.
[3] Lau A, Chen S, Sleiman S, Sorrell T. Current status and future perspectives on molecular and serological methods in diagnostic mycology [J]. Future Microbiol, 2009, 4(9):1185-1222.
[4] Laín A, Elguezabal N, Amutio E, et al. Use of recombinant antigens for the diagnosis of invasive candidiasis [J]. Clin Dev Immunol, 2008, 2008:721950.
[5] Lu Y, Chen YQ, Guo YL, et al. Diagnosis of invasive fungal disease using serum (1→3)-β-D-glucan: a bivariate meta-analysis[J]. Intern Med, 2011, 50(22): 2783- 2791.
[6] Mohr J F, Sims C, Paetznick V, et al. Prospective survey of (1,3)-β-D-glucan and its relationship to invasive candidiasis in the surgical intensive care unit setting [J]. J Clin Microbiol, 2011,40(1): 58-61.
[7] Barbara D, Alexander P, Brian S, at al. The (1, 3)-β-D-Glucan test as an aid to early diagnosis of invasive fungal infections following lung transplantation [J]. Clin Microbiol, 2010, 48(11): 4083-4088.
[8] Li FQ, Ma CF, Shi LN, et al. Diagnostic value of immunoglobulin G antibodies against Candida enolase and fructose-bisphosphate aldolase for candidemia [J].BMC Infect Dis, 2013, 13:253.
[9] 孔小祥,李芳秋,王仕钦,等. 用动物模型评估抗烯醇化酶抗体测定对系统性白念珠菌病的诊断价值[J]. 临床检验杂志,2011, 29(1): 69-71.
[10] Persat F, Ranque S, Derouin F, et al. Contribution of the (1→3)-β-D-glucan assay for diagnosis of invasive fungal infections [J]. J Clin Microbiol, 2008, 46(3): 1009-1013.