侵袭性肺曲霉菌患者血清半乳甘露聚糖动态变化及与CT影像学关系

中国真菌学杂志　 2016, Vol. 11 　Issue (4): 205-208.

侵袭性肺曲霉菌患者血清半乳甘露聚糖动态变化及与CT影像学关系

龚正¹, 占明¹, 张凌云¹, 龚萍², 王艳华³, 崔聪¹, 王永全¹, 向光明¹, 陈世雄¹

1. 三峡大学呼吸疾病研究所宜昌市中心人民医院三峡大学第一临床医学院, 宜昌 443000;
2. 湖北省宜昌市秭归县人民医院, 宜昌 443600;
3. 湖北省宜昌市兴山县人民医院, 宜昌 443700

收稿日期:2015-10-15 出版日期:2016-08-28 发布日期:2016-08-28
通讯作者: 占明,E-mail:5403789@qq.com E-mail:5403789@qq.com
作者简介:龚正,男(汉族),博士,主治医师.E-mail:gongzheng119898@163.com
基金资助:
宜昌市医疗卫生科研基金（KFJ2013009）

Dynamic changes of galactomannan and the relation with CT image in invasive pulmonary aspergillosis

GONG Zheng¹, ZHAN Ming¹, ZHANG Ling-yun¹, GONG Ping², WANG Yan-hua³, CUI Cong¹, WANG Yong-quan¹, XIANG Guang-ming¹, CHEN Shi-xiong¹

1. Institute of respiratory diseases of the three gorges university, Yichang Center People's Hospital, The first clinical medical college of the three gorges university, Yichang 443000, China;
2. Zigui county people's hospital, Zigui 443600, China;
3. Xingshan county people's hospital, Xingshan 443700, China

Received:2015-10-15 Online:2016-08-28 Published:2016-08-28

摘要/Abstract

摘要：

目的观察侵袭性肺曲霉菌感染患者抗真菌治疗前后肺泡灌洗液及血清中半乳甘露聚糖（GM）的水平变化、CT影像学特征及血清中性粒细胞数与GM试验阳性率之间的关系，患者血清中性粒细胞值与GM试验阳性率之间的关系。方法连续性纳入60例确诊侵袭性肺曲霉菌感染患者，观察抗真菌治疗前后肺泡灌洗液和血清GM试验动态水平变化。单因素Logistic回归分析CT侵犯肺叶数、空气新月征、晕轮征、血清中性粒细胞值与GM的关系。结果抗真菌治疗前患者肺泡灌洗液GM平均值均高于血清GM平均值（0.62±0.08 mg/L，60.0%；0.51±0.07 mg/L，31.6%）。同抗真菌治疗前比，患者抗真菌治疗后1个月、2个月、3个月、6个月肺泡灌洗液GM值快速降低（P<0.05），而血清GM数值缓慢降低，仅在第3个月、第6个月降低（P<0.05）。患者CT侵犯肺叶数、晕轮征与肺泡灌洗液、血清中性粒细胞值GM试验阳性率显著相关。结论肺泡灌洗液及血清GM试验可作为IFD疾病诊断及治疗的重要辅助指标。CT影像学特征、血清中性粒细胞值与GM试验阳性率显著相关。

关键词: 侵袭性肺曲霉菌, 肺泡灌洗液, 半乳甘露聚糖

Abstract:

Objective To observe changes of galactomannan(GM) in bronchoalveolar lavage(BAL) and serum,evaluate relationship between GM and CT feature,neutrophil count in serum for invasive fungal disease(IFD).Methods Sixty patients with IFD and were enrolled in this study.The levels of GM were measured in BAL and serum.Univariate logistic regression analysis was performed with GM in BAL and lung lobe number,air crescent sign,halo sign,in CT feature and neutrophil in serum.Result GM in BAL was higher than the GM in serum(0.62±0.08 mg/L,60.0%;0.51±0.07 mg/L,31.6%) before antifungal treatment,compared with before antifungal treatment,the GM in BAL in 1 m 2 m 3 m 6 m decreasd rapidly after antifungal treatment(P<0.05),but the GM of serum decrease slowly,decreasing only in 3 m,6 m(P<0.05).The positive rate of the GM of BAL was in concerned with the amount of invasive lung lobe and halo sign in CT and neutrophil count in serum.Conclusion GM in BAL might be a important marker for diagnosing and efficacy in IFD,GM in BAL was correlated with CT feature and neutrophil count.

Key words: invasive fungal disease, bronchoalveolar lavage, galactomannan

中图分类号:

R519.8

龚正, 占明, 张凌云, 龚萍, 王艳华, 崔聪, 王永全, 向光明, 陈世雄. 侵袭性肺曲霉菌患者血清半乳甘露聚糖动态变化及与CT影像学关系[J]. 中国真菌学杂志, 2016, 11(4): 205-208.

GONG Zheng, ZHAN Ming, ZHANG Ling-yun, GONG Ping, WANG Yan-hua, CUI Cong, WANG Yong-quan, XIANG Guang-ming, CHEN Shi-xiong. Dynamic changes of galactomannan and the relation with CT image in invasive pulmonary aspergillosis[J]. Chinese Journal of Mycology, 2016, 11(4): 205-208.

参考文献

[1] Segal BH.Aspergillosis[J].N Engl J Med,2009,360(18):1870-1884.
[2] Kontoyiannis DP,Marr KA,Park BJ,et al.Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients,2001-2006:overview of the Transplant-Associated Infection Surveillance Network(TRANSNET) Database[J].Clin Infect Dis,2010,50(8):1091-1100.
[3] Walsh TJ,Anaissie EJ,Denning DW,et al.Treatment of aspergillosis:clinical practice guidelines of the Infectious Diseases Society of America[J].Clin Infect Dis,2008,46(3):327-360.
[4] Tsitsikas DA,Morin A,Araf S,et al.Impact of the revised(2008) EORTC/MSG definitions for invasive fungal disease on the rates of diagnosis of invasive aspergillosis[J].Med Mycol,2012,50(5):538-542.
[5] Morrissey CO,Chen SC,Sorrell TC,et al.Galactomannan and PCR versus culture and histology for directing use of antifungal treatment for invasive aspergillosis in high-risk haematology patients:a randomised controlled trial[J].Lancet Infect Dis,2013,13(6):519-528.
[6] Aguado JM,Vazquez L,Fernandez-Ruiz M,et al.Serum galactomannan versus a combination of galactomannan and polymerase chain reaction-based Aspergillus DNA detection for early therapy of invasive aspergillosis in high-risk hematological patients:a randomized controlled trial[J].Clin Infect Dis,2015,60(3):405-414.
[7] Mohammadi S,Khalilzadeh S,Goudarzipour K,et al.Bronchoalveolar galactomannan in invasive pulmonary aspergillosis:a prospective study in pediatric patients[J].Med Mycol,2015,53(7):709-716.
[8] Sadique Z,Grieve R,Harrison DA,et al.An integrated approach to evaluating alternative risk prediction strategies:a case study comparing alternative approaches for preventing invasive fungal disease[J].Value Health,2013,16(8):1111-1122.
[9] Eigl S,Prattes J,Reinwald M,et al.Influence of mould-active antifungal treatment on the performance of the Aspergillus-specific bronchoalveolar lavage fluid lateral-flow device test[J].Int J Antimicrob Agents,2015.
[10] Klont RR,Mennink-Kersten MA,Ruegebrink D,et al.Paradoxical increase in circulating Aspergillus antigen during treatment with caspofungin in a patient with pulmonary aspergillosis[J].Clin Infect Dis,2006,43(3):e23-25.
[11] Ketai L,Jordan K,Busby KH.Imaging infection[J].Clin Chest Med,2015,36(2):197-217,viii.
[12] Kuhlman JE,Fishman EK,Siegelman SS.Invasive pulmonary aspergillosis in acute leukemia:characteristic findings on CT,the CT halo sign,and the role of CT in early diagnosis[J].Radiology,1985,157(3):611-614.
[13] Leeflang MM,Debets-Ossenkopp YJ,Wang J,et al.Galactomannan detection for invasive aspergillosis in immunocompromised patients[J].Cochrane Database Syst Rev,2015,12:doi:10.1002/14651858.