| Objective1.To evaluate the value of serum galactomannan(GM) detection for early diagnosis of invasive aspergillosis(IA) in patients with hematological disease,and to explore the relationship between dynamic detection of serum GM level and anti-fungal treatment outcomes.2.To explore the cinical value on Dynamic detection of serum galactomannan for IA patients after early phase of hematopoietic stem cell transplantation(HSCT),and to analysis the risk factors of IFI in these patients.Methods1.According to the diagnostic criteria of invasive fungal infections in China,the suspicious IFI patients with hematological disease could be divided into proven,clinical and possible IFI patients.The group of excluded IFI patients was control group.2.The serum GM concentration of all the patients was detected by Platelia Aspergillus double-sandwich enzyme linked immunosorbent assay (PADSELISA).And the sensitivity,specificity and predictive values were calculated.Results1.The sensitivity,specificity,positive predictive values and negative predictive values of the PADSELISA were 88%,88.7%,64.7%and 96.9% respectively by using the cut-off value of single≥0.7 and/or consecutive≥0.5.Before GM test,there were 17 clinical IA patients,among which 4 patients had major CT imaging with positive rate of 23.5%.24 patients had major CT imaging in 186 possible IA patients with positive rate of 15%(total 160 patients had CT imaging).The positive rate of GM test were 92.3%and 85.7%respectively.After GM test,there were 59 clinical IA patients.GM positive results ahead sputum culture positive result 5.9 ±4.3d(1-12d),and ahead CT results 6.94±5.35d(0-15d);A progressive reduction of GM level was found in survivors,however,the patients of poor prognosis showed higher antigen titres.The GM false positive rate was about 30%in control group patients who using intravenous injection piperacillin-Tazobactam.The GM level of IA patients after using echinocandin was up in 1 day,and slowed down since that.2.There were total 15 possible IFI patients,in which 13 IA patients among the 45 HSCT patients.13 IA patients with 1 GM(+),and 9 IA patients with 2 consecutive GM(+).Median time of IA infection was +11d(-2-+21)d,1 IA patient was infected after pretreatment,while 12 IA patients happened after HSCT,mainly between +7-+21d.GM positive results ahead clinical symptoms 6.75(3-11)d.There were 27 patients at least 1 GM(+) among 45 HSCT patients.14 patients were GM false positive.The GM false positive rate was 43.8%(14/32).There was 13 patients who had consecutive GM(+).4 patients were GM false positive.The GM false positive rate was 12.5%(4/32).Analysing 14 false positive patients,7 patients happened after pretreatment and before HSCT,and 7 happened after HSCT(6 patients had piperacillin-Tazobactam before test).Median time of false positive was +1(-8-+21)d.By using logist-regression:IFI history increasing infection risk(P<0.05,OR=9.113).The add up happen rate of IFI in HSCT patiens during 1 month after HSCT was 33.3%(15/45).Conclusions1.The PADSELISA for GM detection is a reliable method for early diagnosis and treatment of IA in patients with hematological disease.Comparing with single value,sigle≥0.7 and/or consecutive≥0.5 both be used could increase the sensitivity and had no obviouse decrease on specificity. Comparing with other diagnostic accessory examination,for example,major CT imaging and direct microbiological,GM test had obviouse advantage on the positive rate and time.We can estimate the anti-fungal effect by dynamic detection of serum galactomannan.2.Dynamic detection of serum galactomannan after early phase of hematopoietic stem cell transplantation had clinical value on IA early diagnostic.GM false positive rate could be decreased by using consecutive GM(+).The high false positive rate usually happened after pretreatment,while IA infection mostly happened after +7d.That would be good to early diagnosis of IA that having serum sample twice 1 week.IFI history was IFI risk factor by using multi-regression.
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