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目的探讨血清曲霉菌半乳甘露聚糖抗原(GM)酶联免疫吸附试验(ELISA)检测方法在早期免疫功能低下患者合并肺曲霉菌感染诊断的可行性和指导临床治疗的价值。方法采用ELISA方法检测临床确诊或拟诊的侵袭性肺曲霉菌病患者血清曲霉菌GM抗原的水平后,将其中27例患者随机分为A组(13例)、B组(14例),均给予伏立康唑静脉与口服序贯治疗,在6、8、12周时评价临床疗效:A组检测血清GM、临床特征、痰真菌培养及胸部CT;B组观察临床特征、痰真菌培养及胸部CT。结果临床确诊或拟诊的侵袭性肺曲霉菌病32例,血清GM阳性30例,其中27例患者给予伏立康唑治疗,治疗6周,A组治愈5例,显效6例,好转1例,有效率84.6%;B组治愈7例,显效4例,好转1例,有效率78.6%;治疗8周,A组治愈9例,显效3例,有效率92.3%;B组治愈7例,显效5例,好转1例,有效率85.7%;12周,A组治愈10例,显效3例,有效率100.0%;B组治愈8例,显效5例,有效率92.9%;其中A组1例在11周时因原发性血小板减少死亡,B组1例在8周抗真菌治疗效果欠佳时放弃治疗,两组治疗有效率不同,差异有统计学意义。结论曲霉菌半乳甘露聚糖抗原ELISA检测可用于早期临床诊断侵袭性肺曲霉菌病;以cutoff≥0.5为阳性折点,给予先发抗真菌治疗有重要意义;定期连续观察血G-M可用于肺曲霉菌治疗的病情监测,同时联合胸部CT、痰培养可用于抗真菌治疗的疗效评价。
Objective To investigate the feasibility and clinical value of GM method for the diagnosis of pulmonary infection complicated with pulmonary aspergillosis in early immunocompromised patients. Methods Twenty-seven patients were randomly divided into group A (n = 13) and group B (n = 14), all of whom were treated with ELISA method to detect the level of Aspergillus GM antigens in patients with invasive pulmonary aspergillosis. Voriconazole intravenous and oral administration was given, and the clinical efficacy was evaluated at 6, 8 and 12 weeks: Serum GM, clinical features, sputum fungal culture and chest CT in group A; clinical features, sputum fungal culture and chest CT in group B were observed. Results 32 cases of invasive pulmonary aspergillosis clinically diagnosed or suspected, 30 cases of serum GM positive, of which 27 cases were given voriconazole treatment for 6 weeks, group A cured 5 cases, 6 cases markedly improved in 1 case, the effective rate 84.6%. In group B, 7 cases were cured, 4 cases were markedly improved, 1 case improved, and the effective rate was 78.6%. After 8 weeks of treatment, 9 cases were cured in group A, 3 cases were markedly effective, and the effective rate was 92.3% , Improved in 1 case, the effective rate was 85.7%; 12 weeks, group A cured 10 cases, 3 cases markedly effective rate of 100.0%; B group cured 8 cases, 5 cases markedly effective rate of 92.9%; One week after the death due to primary thrombocytopenia, B group 1 case of antifungal therapy in 8 weeks to give up treatment, the two groups of different treatment efficiency, the difference was statistically significant. Conclusion Aspergillus oryzae galactomannan antigen ELISA test can be used in early clinical diagnosis of invasive pulmonary aspergillosis; to cutoff ≥ 0.5 as a positive turning point, given anti-fungal treatment of primary importance; regular continuous observation of blood GM can be used for lung Aspergillus treatment of disease monitoring, combined with chest CT, sputum culture can be used for anti-fungal efficacy evaluation.