Early Diagnosis And Treatment Research On Hematologic Malignancies With Invasive Fungal Infections

Objective 1.To evaluate the diagnosis and prediction value of serum galactomannan(GM) Platelia Aspergillus Kit in malignant hematologic disease complicated with invasive fungal infections(IFI).2.To investigate the efficacy of intravenous administration of itraconazole on invasion fungal infections in patients with hematologic malignancies.3.To establish computer aided early diagnosis system of malignant hematologic disease complicated with invasive fungal infections(IFI). Methods 1.644 serum samples obtained from 135 high risk patients were collected, and ELISA assay was used to analyse the change of GM antigen.2.Using itraconazole to treat 127 patients with hematologic malignancies affiliating invasive fungal infections,retrospective analyzing the therapeutic result.3.304 cases obtained from 1997 to 2007 in Nanfang hospital,and adopt binary logistic analysis to establish regression model.Computer program was built base on this results.Results 1.According to the classification criterion of IFI,the GM positive patient in proven, probable,possible and improbable IFI groups were 5,9,32,and 6,respectively;And the positive rate in every groups were respectively 71.4%,64.3%,43.8%and 14.6%. The sensitivity and specificity of the galactomannan ELISA assay were 0.67 and 0.85 and the positive and negative predictive values were 0.70 and 0.83 respectively.The therapic effect of amphotericin B or itraconazole to GM positive patient is superior than that of Fluconazol,but which was not founded in GM negative patients.After antithngal therapy,,the average OD values of the GM positive patients decreased from 2.02±0.62 to 0.63±0.17(t=15.651,P=0.000),But in GM negative patients,the number were 0.38±0.22 and 0.33±0.21(t=1.609,P=0.112).2.The total efficacy rate was 47.2%(60/127).The efficacy rates of the patients with confirmed diagnosis,with clinical diagnosis and with recommended diagnosis were 66.7%(16/24),51.5%(33/64),28.2%(11/39) respective.The efficacy rate of recommended diagnosis group was obviously lower than confirmed diagnosis group(x~2=8.974,P=0.004) and lower than clinical diagnosis group(x~2=5.403,P=0.025).The adverse side effect of itraconazole was little.The efficacy rates in groups which were checked out fungus, accepted transplantation,used hormone and treated with loading dose of itraconazole are higher than control group(x~2=25.321,P=0.000;x~2=13.023,P=0.000; x~2=16.552,P=0.000;x~2=13.119,P=0.000).3.The regression model's Classification is 95.4%,and the model coefficients is 0.000.The computer program was used in Nanfang hospital,and the validity is 92.3%.Conclusion 1.The sensitivity of galactomannan ELISA assay was moderate,but its specificity was high.The patient with high risk factor whose GM test is positive should begin antifungle therapy immediately,but the negative result can not exclusive IFI.The change of GM values can be as a reliable index to predict the antifungle effect.2.Itraconazole can treated patients with hematologic malignancies affiliating invasive fungal infections effectually and safety.3.Computer aided system is effective to help to early diagnose the malignant hematologic disease complicated with invasive fungal infections.