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β-D葡聚糖和白色念珠菌芽管抗体检测在ICU患者侵袭性念珠菌感染的诊断价值EstrellaMart?′n-Mazuelos，AnaLoza等发表于IntensiveCareMed()41:–研究目的（purpose）通过对名无中性粒细胞减少的患者的前瞻性队列研究，评估(1→3)-β-D葡聚糖（BDG）和白色念珠菌芽管抗体（CAGTA）在侵袭性念珠菌感染（IC）的诊断价值。Toassesstheperformanceof(1→3)-β-D-glucan(BDG)andCandidaalbicansgermtubeantibody(CAGTA)forthediagnosisofinvasivecandidiasis(IC)inaprospectivecohortofunselected,non-neutropenicICUpatients.研究方法（method）每周进行两次BDG(阳性阈值≥80pg/ml)和CAGTA（阳性阈值≥1/）检查。混杂因素包括阿莫西林克拉维酸及哌拉西林他唑巴坦治疗，近期手术治疗，革兰氏阳性菌血流感染，肾脏替代治疗和肠内营养。患者分为既无定植也无感染组（n=29），念珠菌定植组（n=63）（低度n=32，高度n=31），侵袭性念珠菌感染组（n=15）。BDG(cutoffpositivityC80pg/mL)andCAGTA(cutoffpositivityC1/)assayswereperformedtwiceaweek.Confoundingfactorsincludedamoxicillin–clavulanateandpiperacillin–tazobactamtreatments,recentsurgery,Gram-positivebloodstreaminfection,renalreplacementtherapy,andenteralnutrition.Patientswereclassifiedasneithercolonizednorinfected(n=29),Candidaspp.Colonization(n=63)(lowgrade,n=32;highgrade,n=31),andinvasivecandidiasis(IC)(n=15).研究结果（result）：与其他组相比，BDG水平在IC组和高度定植组较高（p=0.），并且两次连续检测结果≥80pg/ml能够鉴别出IC（敏感性80%，特异性75.7%）。对于IC和念珠菌定植的鉴别，BDG的AUC最大值为0.（95%CI0.-0.），而CAGTA的AUC最大值为0.（95%CI0.-0.）。进行抗真菌治疗的IC患者中未发现BDG和CAGTA动力学有明显变化。在既无定植也无感染组或低度定植组，混杂因素与BDG阳性率显著升高不相关。BDGlevelswerehigherinpatientswithICandhigh-gradecolonizationthanintheemaininggroups(p=0.),andtwoconsecutivemeasurementsC80pg/mLdiscriminatedICfromtheremaininggroups(sensitivity80%,specificity75.7%).ForthediscriminationbetweenICandCandidaspp.colonization,theAUCforthemaximumvalueofBDGwas0.(95%CI0.–0.)andforthemaximumvalueofCAGTA0.(95%CI0.–0.).SignificantchangesofBDGandCAGTAkineticsinICpatientstreatedwithantifungalswerenotobserved.Inpatientsneithercolonizednorinfectedorwithlow-gradeCandidaspp.colonization,noneoftheconfoundingfactorswasassociatedwithasignificantincreaseinBDGpositivity.结论（conclusion）连续两次BDG水平≥80pg/ml可鉴别IC和高度定植，但全身抗感染治疗的效果不能通过生物标志物动力学变化进行监测。在无定植也无感染或低度定植的患者，BDG水平不受混杂因素的干扰。TwoconsecutiveBDGlevelsC80pg/mLalloweddiscriminationamongICandhigh-gradecolonization.Systemicantifungaltherapycouldnotbemonitoredwithbiomarkerkinetics,andBDGlevelswerenotsubjecttointerferencebyconfoundingfactorsineithercolonizedorinfectedpatientsorwithlow-gradecolonization.文/杨岚文审/谢剑锋编辑/张星星审核/刘松桥 赞赏 长按 |
