综述—真菌早期诊断技进展.doc

深部真菌感染早期诊断技术进展 Recent advances in early diagnostic approaches of invasive fungal infection 赵勇 王红 首都医科大学附属北京友谊医院 100050 Summary: Fungi and Bacterium have a good balance in living human body. Due to wide application of antibiotics ,immunosuppressants and hormones in clinical patients, and outspread of organic transplantation and catheter intubation, invasive fungal infection on immunocompromised host contribute most to morbidity and mortality of those patients. Invasive fungal infection includes candidemia, aspergillosis,and cryptococcosis, which has various pathogen. This review involves traditional bacteriological methods, image technique and various laboratory tests, such as detection of (1,3)-b-d-glucan and galactomannan, Polymerase chain reaction (PCR) on fungal DNA, and so forth. The recently licensed sandwich enzyme-linked immunoabsorbent assay for the detection of Aspergillus galactomannan antigen has been employed in clinical practice. As documented, a sensitivity of 75%, specificity of 100%, and positive and negative predictive values of 100 and 97%, respectively, take more attention. Preventative strategies against fungal colonization and infection are critical in high-risk patients of invasive fungal infection and prompt treatment depends on the ability of serological and molecular diagnostics to detect infection earlier. Combination of above methods will benefit to earlier dignosis of invasive fungal infection. Multicenter clinical trials on efficiency of those diagnostic techniques and empiric treatment are urgently needed. 真菌在人体中,与细菌之间起着重要的微生态平衡作用。近年来,随着抗生素、免疫抑制剂及皮质类固醇激素在临床上广泛应用,器官移植、导管插管等普遍开展,深部真菌感染率越来越高。深部真菌感染免疫功能下降的患者仍是感染相关发病率和死亡率的最显著的原因。据统计,近30年深部真菌感染的发病率增加了3～5倍,真菌感染已成为艾滋病的重要死亡原因之一。引起深部真菌感染的病原菌主要有白色念珠菌、曲菌和隐球菌等。在白色念珠菌感染导致的死亡率由于广泛预防性应用氟康唑下降的同时，曲霉菌导致感染在过去十年增长3倍，而其他霉菌如镰刀霉、接合菌导致的感染的报道也日渐增加。1 深部真菌感染的定义同真菌定植不同。真菌定植是不存在任何临床感染的症状和体征时一处或多处浅表培养真菌阳性。而深部真菌感染分为确诊和疑似感染：确诊深部真菌感染需满足下列标准之一：1）血、脑脊液、腹水和活检标本存在真菌；2）眼科学证据；3）发热情况下从至少两处表浅部位分离出真菌并且b-D葡聚糖大于11pg/ml；4）在影像学提示肺