The Role Of Serum Galactomannan Detection In Early Diagnosis Of Invasive Aspergillosis In Patients With Hematological Disease

Objective To evaluate the value of serum galactomannan(GM) detection for early diagnosis of invasive aspergillosis(IA) in patients with hematological disease.Methods 68 patients with hematological disease of suspected aspergillosis were continuously detected values of serum GM detection using enzyme-linked immunosorbent assay and grouped into proven IA, possible IA and excluded IA according to the diagnostic standard which our country formulated about invasive fungal infection in blood diseases/cancer patients combined with retrospective diagnosis standard. We analysised the relationship of GM detection and early diagnosis,treatment and prognosis of IA.Results①We continuously detected values of serum GM detection in 68 patients with hematological disease of suspected aspergillosis and used the value of GM≥0.5 the kit recommending as the positive standard. we found that the positive rate of GM detection was 50.0%(34/68). According to the diagnostic standard of IA, we follow-up found that proven IA, possible IA and excluded IA were 13(38.2%),12(35.3%)and 9(26.5%)respectively in 34 patients with GM positive .The compliance rate of positive in GM value and clinical diagnosis of IA was 73.5%(25/34). The compliance rate of negative in GM value and clinical excluded IA was 82.4%(28/34).②Compared with traditional methods,GM detection preceded the detection time of blood culture, sputum culture for fungi, the development of clinical manifestations and characteristic findings on lung CT.③when the preemptive antifungal therapy were administrated according to positive results of GM,the remission rate of treatment was higher(P=0.028).④Serum concentrations of GM declined when anti-fungal treatment for IA was effective,Otherwise the concentrations of GM were increased. Quantitive results of serum GM can represent the status of IA and may correlate the concentration of serum GM with treatment efficacy.⑤68 grouped patients were divided into proven IA(15), possible IA(16) and excluded IA(37) according to the diagnostic standard of IA. We analysised results using proven IA as true positive and excluded IA as true negative.Comparing differences between the values of serum GM detection in each group when positive critical values of GM detection were 1.5,1.0,0.8 and 0.5 respectively, We found that when the positive value is 0.5, the sensitivity and specificity of GM detection in the clinical diagnosis of IA were both better ,86.7%, 75.7% respectively.It consistented with the positive value the kit recommending.Conclusions GM ELISA test is a rapid,reliable and applied method for early diagnosis and treatment of IA,with good sensitivity and specificity. GM ELISA test is a good direction for preemptive antifungal therapy in patients with haematological disease at risk of IA. Continuously monitoring levels of GM is important in judging the efficacy of treating IA.