摘要
目的评价血清半乳甘露聚糖(GM)检测对侵袭性肺曲霉病(IPA)的诊断价值。方法清洁级健康成年 SD 大鼠90只,按随机区组设计分为烟曲霉感染组、白假丝酵母菌感染组、毛霉感染组、肺炎链球菌感染组、烟曲霉口咽定植组,每组18只。气管插管滴入法建立大鼠侵袭性肺部真菌感染和细菌感染动物模型。经鼻腔和口咽滴入法建立烟曲霉口咽定植动物模型。分别于接种完成后第3天、第7天、第12天处死大鼠,取心脏血,采用 Platelia Aspergillus(法国 Bio-Rad 公司)试剂盒检测血清 GM,取肺组织行组织病理学检查。多组间比较采用单因素方差分析,实验数据经 SPSS 统计软件处理。结果除曲霉定植组外,光镜下各组大鼠肺组织均见明显炎症反应,真菌感染大鼠在肺组织中可见真菌菌丝或孢子。烟曲霉、白假丝酵母菌、毛霉、肺炎链球菌感染组和烟曲霉口咽定植组大鼠血清 GM 的吸光度指数均值分别为1.69±0.29、0.89±0.46、0.87±0.39、0.77±0.34和0.90±0.49,烟曲霉感染组与其他4组分别比较,差异明显。以吸光度指数为1.5作为诊断阈值诊断 IPA 的敏感性、特异性、阳性预测值和阴性预测值分别为78.6%、87.5%、57.9%和94.9%;以吸光度指数为1.5时,第3天、第7天和第12天血清 GM 检测诊断 IPA 的敏感性分别为60%、80%和100%。结论 GM 检测可区分 IPA 与白假丝酵母菌感染、毛霉感染、肺炎链球菌感染和烟曲霉口咽定植;GM 检测诊断 IPA的敏感性随感染时间的延长而增加;以吸光度指数为1.5作为诊断阈值诊断 IPA 的敏感性、特异性较理想。
Objective To assess the value of Aspergillus galactomannan （GM） double-direct sandwich enzyme-linked immunosorbent assay （ELISA） in the diagnosis of invasive pulmonary aspergillosis （IPA）. Methods Ninety adult SD rats were randomly divided into 5 groups, including 4 groups of pulmonary infection by Aspergillus fumigatus （ A. fumigatus ） , candida albicans , mucor, and streptococcus pneumoniae, respectively, and a colonization group by A. fumigatus in the pharynx oralis （n = 18 each）. For the infection models, suspensions of pathogenic bacteria and fungi were instilled into the lungs of the rats by tracheal intubation. For the colonization model, the suspension of A, fumigatus was applied to the nasal cavity and pharynx oralis of the rats. The animals were sacrificed on days 3, 7, and 12 after inoculation, and blood samples were obtained by cardiac puncture and used for GM detection. The lung tissues were prepared for routine pathology examination, and hexamethylene tetramine silver staining was used to detect the fungi. A double-direct sandwich ELISA was employed to detect GM optical density index in the serum samples. Result The lung tissues of rats infected with A. fumigatus, candida albicans, mucor and streptococcus pneumoniae all showed remarkable inflammatory reactions, and hyphae were observed in rats with fungal infection （including A, fumigatus and mucor）, and spores in rats infected with candida albicans, The lung tissues of the A, fumigatus colonization rats showed no inflammatory reactions, The serum GM optical density index of the groups infected with A, fumigatus, candida albicans, mucor and streptococcus pneumoniae, and the A, fumigatus colonization group were 1, 69 ± 0. 29, 0, 89 ± 0.46, 0. 87 ± 0.39, 0. 77 ± 0.34 and 0.90 ± 0. 49, respectively. The serum GM optical density index of the IPA group was higher than those of the other 4 groups （P 〈 0. 05）, If the cutoff ODI was 1.5, the sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） for diagnosis of IPA in the rats were 78. 6%, 87. 5% , 57.9% and 94. 9%, respectively. The sensitivity for A, fumigatus infection on days 3, 7, and 12 was 60%, 80% and 100%, and the specificity was 95.5%, 81.0% and 85.7%, respectively. Conclusion GM detection could distinguish aspergillus infection from candida albicans, mucor, streptococcus pneumoniae infection and aspergillus colonization. The sensitivity of the test for the diagnosis of IPA tended to be higher with longer duration of infection. A cutoff ODI of 1.5 showed the best sensitivity and specificity for IPA in this rat model.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2007年第11期839-843,共5页
Chinese Journal of Tuberculosis and Respiratory Diseases
