用于诊断侵袭性曲霉菌病的血清抗原检测:对五种曲霉菌抗原检测方法和一种β-D-葡聚糖检测方法的回顾性比较。

IF 6.1 2区 医学 Q1 MICROBIOLOGY Journal of Clinical Microbiology Pub Date : 2024-11-04 DOI:10.1128/jcm.00950-24
Thilo Schub, Isabel Klugherz, Johannes Wagener, Juergen Prattes, Martin Hoenigl, Sebastian Suerbaum, Jürgen Held, Karl Dichtl
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引用次数: 0

摘要

侵袭性曲霉菌病(IA)是一种危及生命的感染。早期和特异性诊断是确保适当治疗的关键。血液抗原检测是一种广泛而便捷的诊断方法。目前有多种检测曲霉抗原和泛真菌抗原β-1,3-D-葡聚糖(BDG)的方法,但仍缺乏全面的比较。使用两种酶联免疫吸附测定(ELISA)(Bio-Rad 和 Euroimmun)、一种化学发光免疫测定(CLIA)(Vircell)、一种 BDG 测定(Fujifilm Wako)和两种护理点(PoC)测定(Immy sōna 和 OLM)对 82 名已证实/可能(11/71)的 IA 患者和 52 名对照者的血样进行了检测。PoC 检测法通过目测进行评估,并使用自动读出系统。在82名IA患者中,37人接受过实体器官移植(SOT),25人接受过造血干细胞移植(HSCT)。八种检测系统的灵敏度和特异性分别为 27% 至 71% 和 64% 至 100%。据估计,IA的发病率为10%,测试结果的阳性预测值为14%-100%,阴性预测值为91%-95%。除 GM 外,所有检测项目的曲线下面积(AUC)均低于 0.7。当定量检测的临界值归一化为接近 95% 的特异性时,灵敏度在 14% 至 40% 之间。在 PoC 检测中使用自动读出系统有很大的影响。将不同的检测方法结合起来并没有带来更好的检测策略。对单一血清样本进行曲霉菌抗原检测的灵敏度较低。由于特异性问题,大多数检测方法不适合用于筛查目的。不同的检测方法可满足不同诊断环境下的不同需求。
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Serum antigen tests for the diagnosis of invasive aspergillosis: a retrospective comparison of five Aspergillus antigen assays and one beta-D-glucan assay.

Invasive aspergillosis (IA) is a life-threatening infection. Early and specific diagnosis is pivotal to ensure adequate therapy. Antigen testing from blood is a widespread and convenient diagnostic approach. Various tests for the detection of Aspergillus antigen as well as for the panfungal antigen β-1,3-D-glucan (BDG) are available, for which comprehensive comparisons are still lacking. Blood samples of 82 proven/probable (11/71) IA patients and 52 controls were tested using two enzyme-linked immunosorbent assays (ELISAs) (Bio-Rad and Euroimmun), one chemiluminescent immunoassay (CLIA) (Vircell), one BDG assay (Fujifilm Wako), and two point of care (PoC) assays (Immy sōna and OLM). PoC assays were evaluated visually and used automated read out systems. Of the 82 IA patients, 37 had received solid organ transplantation (SOT) and 25 hematopoietic stem cell transplant (HSCT). Sensitivities and specificities for the eight test systems ranged from 27% to 71% and from 64% to 100%. Estimating a 10% prevalence of IA, test performance would have resulted in positive and negative predictive values of 14%-100% and 91%-95%. Areas under the curve (AUCs) for all tests except GM were below 0.7. When the cut-off values for quantitative tests were normalized to a specificity close to 95%, sensitivities ranged from 14% to 40%. The use of automated read out systems for the PoC assays had a significant impact. Combining different tests did not result in better test strategies. Sensitivity of Aspergillus antigen testing from single serum samples is low. Due to specificity issues, the majority of tests is not suited for screening purposes. The different assays can meet different needs in different diagnostic settings.

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来源期刊
Journal of Clinical Microbiology
Journal of Clinical Microbiology 医学-微生物学
CiteScore
17.10
自引率
4.30%
发文量
347
审稿时长
3 months
期刊介绍: The Journal of Clinical Microbiology® disseminates the latest research concerning the laboratory diagnosis of human and animal infections, along with the laboratory's role in epidemiology and the management of infectious diseases.
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