G試驗(yàn)和GM試驗(yàn)真菌檢測課件

G試驗(yàn)和GM試驗(yàn)

----真菌檢測1ppt課件.真菌感染會(huì)帶來怎樣的后果呢？2ppt課件.Mortality,lengthofhospitalization,andcostsassociatedwithinvasivefungalinfectionsinhigh-riskpatients.MenzinJ,MeyersJL,FriedmanM,PerfectJR,LangstonAA,DannaRP,PapadopoulosG.AmJHealthSystPharm.2009Oct1;66(19):1711-7.3ppt課件.4ppt課件.5ppt課件.6ppt課件.7ppt課件.8ppt課件.9ppt課件.G試驗(yàn)和GM試驗(yàn)

----真菌檢測馬桂伶2011-3-1610ppt課件.深部真菌白色念珠菌新型隱球菌曲霉菌毛霉菌11ppt課件.傳統(tǒng)的檢測方法主要為血培養(yǎng)和組織活檢，但血培養(yǎng)歷時(shí)太長，且陽性率較低。近年來，用于檢則真菌的抗原、抗體及代謝產(chǎn)物的血清學(xué)檢查已用于深部真菌感染的實(shí)驗(yàn)室檢測。

目前的血清學(xué)檢查主要針對(duì)真菌胞壁或胞內(nèi)成分——beta-葡聚糖、甘露糖、烯醇化酶和Cand-Tec抗原等。12ppt課件.G試驗(yàn)-（1，3）-β-D葡聚糖試驗(yàn)G試驗(yàn)檢測的是真菌細(xì)胞壁成分(1，3)-β-D葡聚糖，由于(1，3)-β-D-葡聚糖僅廣泛存在于真菌的細(xì)胞壁中，當(dāng)真菌進(jìn)入人體血液或深部組織后，經(jīng)吞噬細(xì)胞的吞噬、消化等處理后，(1，3)-β-D-葡聚糖可從胞壁中釋放出來，從而使血液及其它體液中(1，3)-β-D-葡聚糖含量增高。

當(dāng)真菌在體內(nèi)含量減少時(shí)，機(jī)體免疫可迅速清除(1，3)-β-D-葡聚糖。

在淺部真菌感染中，(1，3)-β-D-葡聚糖未被釋放出來，故其在體液中的量不增高。13ppt課件.

20世紀(jì)90年代初發(fā)現(xiàn),(1-3)-beta-D-葡聚糖可特異性激活自鱟變形細(xì)胞溶解產(chǎn)物提取的G因子,從而旁路激活鱟試驗(yàn),此過程稱為G試驗(yàn)。臨床上,由于深部真菌感染的嚴(yán)重程度常常與血漿多糖的升高水平一致,故G試驗(yàn)可協(xié)助深部真菌感染的診斷(包括念珠菌感染和曲霉菌感染等)。14ppt課件.GM實(shí)驗(yàn)-半乳甘露聚糖試驗(yàn)甘露糖是目前研究最為廣泛的一種抗原,廣泛存在于真菌胞壁中,是真菌胞壁的重要組成成分.15ppt課件.Plasma(1-3)-beta-Dglucanmeasurementindiagnosisofinvasivedeepmycosisandfungalfebileepisodes目的：探討(1-3)-beta-Dglucan在篩查侵襲性真菌感染及

真菌性發(fā)熱中的價(jià)值。方法：檢測了202例病員標(biāo)本，以(1-3)-beta-D-葡聚糖

的血漿濃度20pg/ml為界值,41例

確診病員(以活

檢和培養(yǎng)陽性為標(biāo)準(zhǔn))，37例為陽性,陽性率為90%;59例其他原因所致發(fā)熱者全部陰性,陰性率為100%結(jié)論：(1-3)-beta-D-葡聚糖可用于早期診斷深部真菌感

染,其缺點(diǎn)是不能定性,且此法不能檢測出隱球菌

感染,可能是因?yàn)殡[球菌具有厚壁胞膜。ObayashiT,YoshidaM,MoriT,etal.Plasma(1，3)-beta-Dglucanmeasurementindiagnosisofinvasivedeepmycosisandfungalfebileepisodes[J].Lancet,1995,345(1):17-20.16ppt課件.17ppt課件.Karageorgopoulos

DM,b-D-GlucanAssayfortheDiagnosisofInvasiveFungalInfections:AMeta-analysis,ClinicalInfectiousDiseases.2011;52(6):750–7718ppt課件.76.8%85.3%19ppt課件.conclusionBDGhasgooddiagnosticaccuracyfordistinguishingprovenorprobableIFIsfromnoIFIs.Itcanbeusefulinclinicalpractice,ifimplementedinthepropersetting.20ppt課件.Toupdatethe

case-fatalityrate(CFR)

associatedwithinvasiveaspergillosisaccordingtounderlyingconditions,siteofinfection,andantifungaltherapy,dataweresystematicallyreviewedandpooledfromclinicaltrials,cohortorcase-controlstudies,andcaseseriesof≥10patientswithdefiniteorprobableaspergillosis.Subjectswere1941patientsdescribedinstudiespublishedafter1995thatprovidedsufficientoutcomedata;casesincludedwereidentifiedbyMEDLINEandEMBASEsearches.ThemainoutcomemeasurewastheCFR.Fiftyof222studiesmettheinclusioncriteria.TheoverallCFRwas58%,andtheCFRwashighestforbonemarrowtransplantrecipients(86.7%).

AmphotericinBdeoxycholateandlipidformulationsofamphotericinBfailedtopreventdeathinone-halftotwo-thirdsofpatients.MortalityishighdespiteimprovementsindiagnosisanddespitetheadventofnewerformulationsofamphotericinB.Underlyingpatientconditionsandthesiteofinfectionremainimportantprognosticfactors.LinSJ,SchranzJ,TeutschSM.Aspergillosiscase-fatalityrate:systematicreviewoftheliterature.ClinInfectDis.2001;32:358–366.21ppt課件.ChristopherD,DiagnosisofInvasiveAspergillosisUsingaGalactomannanAssay:AMeta-Analysis,ClinicalInfectiousDiseases2006;42:1417–2722ppt課件.23ppt課件.00.930.0.710.6100.8924ppt課件.ConclusionsGMtesthasmoderateaccuracyfordiagnosisofinvasiveaspergillosisinimmunocompromisedpatients.Thetestismoreusefulinpatientswhohavehematologicalmalignancyorwhohaveundergonehematopoieticcelltransplantation25ppt課件.GM試驗(yàn)在非血液病患者真菌檢測中的應(yīng)用26ppt課件.27ppt課件.28ppt課件.29ppt課件.conclusion1TheprevalenceofinvasiveaspergillosisinthegroupofpatientswithCOPDwas16.13%。2The1ng/mlcut-offshowedahigherpositivepredictivevalue(100%)andcomparablenegativepredictivevaluetothe0.5ng/mlcut-off.ThevalueofthetestinCOPDpatientsyieldedsimilarresults.30ppt課件.COPDpatientsmayhaveincreasedsusceptibilityto

fungalinvasiveinfectionforseveralreasons(1)structuralchangesinlungarchitecturerelatedtothepulmonarydisease;(2)thecommonuseoflong-termorrepeatedshort-termsteroidtreatmentsasanadditionalimmunosuppressivefactor;(3)frequenthospitalisationandantibiotictreatment,leadingtoexposuretoselectedfungalpathogens;(4)co-morbidityfactorssuchasalcoholism,diabetesmellitusormalnutrition.F.Ader.Invasivepulmonaryaspergillosisinchronicobstructivepulmonarydisease:anemergingfungalpathogen.ClinMicrobiolInfect,2005;11:427–42931ppt課件.GM試驗(yàn)在COPD合并真菌感染診斷中的應(yīng)用32ppt課件.33ppt課件.34ppt課件.conclusionInCOPDpatients,invasivepulmonaryaspergillosiscurrentlycarriesaverypoorprognosis.Outcomecouldperhapsbeimprovedbymorerapiddiagnosisandprompttherapywithvoriconazole.35ppt課件.重度COPD患者合并侵襲性曲霉菌病的結(jié)果？36ppt課件.37ppt課件.38ppt課件.E39ppt課件.GMtestresult40ppt課件.GMtestandmortalityGMtestAllpatients(%)IPApatients(%)Non-IPApatients(%)Firsttestpositive6081.833.3Atlestonepositive54.683.320Positiveforboth72.787.533.341ppt課件.GroupMortalityAllpatients

IPAgroup

non-IPAgroupAspergillusisolated33.3%(30/90),73.7%(14/19),22.5%(16/71),

70.0%(14/20).42ppt課件.conclusion1TheincidenceofIPAintheCOPDpatientsadmittedtotheICUwas11.1%(19/171)2serumGMshouldbetestedatleasttwiceaweektoachieveearlydiagnosisofaspergillosis.3atleastonepositiveresultoftwoconsecutiveGMtestsappearstobeusefulinthediagnosisofIPAincriticallyillCOPDpatientsinanICU.4positiveserumGMresultscombinedwiththeisolationofAspergillusfromrespiratorysamplesmaybeapotentialmarkerofhighmortality.43ppt課件.GGM試驗(yàn)的聯(lián)合應(yīng)用44ppt課件.45ppt課件.RepresentativekineticsofBG()andGM()indifferentpatients.(a)ProvenIAinapatientwithacutemyeloidleukemiawhorespondedtotreatmentwithamphotericinBandcaspofungin.46ppt課件.(b)ProvenIAinapatientwithchroniclymphocyticleukemiawhodidnotrespondtotreatmentwithamphotericinB.47ppt課件.(c)False-positiveBGresultsinapatientwithmultiplemyelomaandnoIA.48ppt課件.(d)False-positiveGMresultsinapatientwithnon-Hodgkin’slymphomaandnoIA.49ppt課件.(e)NegativeBGandGMresultsinapatientwithacutemyeloidleukemiaandnoIAwhowascolonizedbyC.albicansandC.glabrata.50ppt課件.(f)NegativeBGandGMresultsinapatientwithchroniclymphocyticleukemiaandnoIAwhowascolonizedbyC.albicans51ppt課件.conclusion1Thesensitivity,speci?city,andpositiveandnegativepredictivevaluesforGMandBGwereidentical,87.5,89.6,70,and96.3%

2

False-positivereactionsoccurredatarateof10.3%inbothtests,butthepatientsshowingfalse-positiveresultsweredifferentineachtest.Bothtestsanticipatedtheclinicaldiagnosis,computedtomographyabnormalities,andtheinitiationofantifungaltherapyinmostpatients,butBGtendedtobecomepositiveearlierthanGM.3Acombinationofthetwotestsimprovedthespeci?city(to100%)andpositivepredictivevalue(to100%)ofeachindividualtestwithoutaffectingthesensitivityandnegativepredictivevalues.

BGandGMdetectionareusefultestsforthediagnosisofIAinhigh-riskhematologicalpatients,andthecombinationofthetwotestswasveryusefultoidentifyfalse-positivereactionsbyeachtest.52ppt課件.總之：G、GM試驗(yàn)都可用于侵襲性真菌感染的檢測，G試驗(yàn)對(duì)念珠菌及曲霉菌都有較好的敏感度，但不能區(qū)分出是念珠菌還是曲霉菌感染；GM試驗(yàn)對(duì)曲霉菌感染有較好的特異度。聯(lián)合GGM試驗(yàn)對(duì)臨床診斷侵襲性曲霉菌病有較好的價(jià)值，但這兩個(gè)試驗(yàn)用于隱球菌檢測，缺乏臨床證據(jù)，GM試驗(yàn)?zāi)芊裼糜谀钪榫臋z測仍不明確。53ppt課件.感謝聆聽不妥之處，望批評(píng)指正54ppt課件.55ppt課件.DiagnosisProveninvasiveFIProbableinvasiveFIPossibleinvasiveFIHistopathologicorcytopathologicexaminationshowinghyphaefromneedleaspirationorbiopsyspecimenwithevidenceofassociatedtissuedamage;orpositivecultureresultforasampleobtainedbysterileprocedurefromnormallysterileandclinicallyorradiologicallyabnormalsiteconsistentwithinfectionAtleast1hostfactorcriterion;1microbiologicalcriterion;and1major(or2minor)clinicalcriteriafromabnormalsiteconsistentwithinfectionAtleast1hostfactorcriterionand1microbiologicalor1major(or2minor)clinicalcriteriafromabnormalsiteconsistent56ppt課件.Typeofdiagnosticcriteria

---hostfactors1Neutropenia(<500neutrophils/mm3for110days);2persistentfeverfor>96hrefractorytoappropriatebroad-spectrumantibacterialtreatmentinhigh-riskpatients;3bodytemperatureeither>38Cor<36Candanyofthefollowingpredisposingconditions:①prolongedneutropenia(110days)inprevious60days,②recentorcurrentuseofsigni?cantimmunosuppressiveagentsinprevious30days,③provenorprobableinvasiveFIduringpreviousepisodeofneutropenia,④coexistenceofsymptomaticAIDS;⑤signsandsymptomsindicatinggraft-versus-hostdisease,particularlysevere(grade2)orchronicextensivedisease;⑥prolonged(13weeks)useofcorticosteroidsinprevious60days.57ppt課件.Typeofdiag