侵袭性真菌病诊断的新指标1→3‐β‐D‐葡聚糖.doc

PAGE PAGE 1 侵袭性真菌病诊断的新指标1→3‐β‐D‐葡聚糖 DiagnosticPerformanceofthe(1→3)‐β‐d‐GlucanAssayforInvasiveFungalDisease ClinicalInfectiousDiseases2009;49:1650–1659 Background.Diagnosisofinvasivefungaldisease(IFD)ischallenging,anditremainsasignificantcauseofmorbidityandmortalityinimmunocompromisedpatients.The(1→3)‐β‐d‐glucan(BG)assaymaybeausefuladjunct,butitsdiagnosticperformanceisnotwellcharacterized. Methods.WeretrospectivelyassessedthediagnosticindicesoftheBGassayinpatientsatriskofIFDwhohadacompatibleclinicalsyndromeforthediagnosisofIFDaweekafterinitialBGtestingandattheendofthehospitalizationassociatedwiththefirstBGvalue.PatientswithIFDwereclassifiedaccordingtocurrentEuropeanOrganizationforResearchandTreatmentofCancer–MycosesStudyGroupcriteria,independentofBGresults. Results.Atotalof1308BGassayswereperformedfor871patients.OnehundredtwelveprovenorprobableIFDcaseswerediagnosedwithin1weekafterinitialtesting,and116caseswerediagnosedbytheendofhospitalization.SensitivityofaninitialBGlevel80pg/mLforIFDat1weekwas0.64(95%confidenceinterval[CI],0.55–0.73),specificitywas0.84(95%CI,0.81–0.86),thepositivelikelihoodratiowas3.93(95%CI,2.94–5.26),andthenegativelikelihoodratiowas0.43(95%CI,0.31–0.59).Albumin,intravenousimmunoglobulin,andhemodialysiswereassociatedwithelevatedBGlevelsinpatientswithoutIFD(oddsratio,4.78;95%CI,2.59–8.80).Afterexcludingpatientswiththesefactors,specificityandthepositivelikelihoodratioofaninitialBGlevel80pg/mLincreasedslightly.EmpiricalsystemicantifungaltreatmentdidnotreduceoverallBGsensitivity.Sensitivitywasslightlyloweramongpatientswithhematologicmalignancyorstemcelltransplantation.ConsiderationofBGresultswouldhaveincreasedthediagnosticcertaintytoprobablein54%ofpossibleIFDcases. Conclusions.BGlevelappearstobeafairdiagnosticadjunctforIFDinpatients[color=red]withappropriatepretestprobability[/color]andasuggestiveclinicalsyndrome,especiallywhencheckedseriallyinpatientsnotreceivingfactorsassociatedwithanelevatedBGlevelintheabsenceofIFD. 译文： 背景：侵袭性真菌病（IFD）的诊断现在还