Discuss Serum Galactomannan Detection In The Diagnostic Evaluations Of Invasive Pulmonary Aspergillosis (with The Retrospective Study Of 45 Clinical Cases)

Object:In the last several decades, along with the extensive applications of hormone, antibiotics, and immunity inhibitors etc., current world population which died from invasive pulmonary fungi infection presents consecutive up-trend, especially the mortality rate of invasive pulmonary aspergillosis(IPA) compares with 20 years ago raised by 800%, seriously threat to human's health. It is misdiagnosised usually as pneumonia, pulmonary cancer,tuberculosis etc., owning to its concealment and non-specificity; neglecting a best opportunity for treatment is a major factor contribute to its high mortality.The traditional diagnostic methods which are time-consuming,low positive rate,low sensitivity and specificity,such as iconography,microscopic examination, traditional culture and histopathological examination etc.,have a limited role in the diagnosis of IPA. Therefore, how to improve the diagnosis of IPA has become a urgent need of common concern for medical personnel at home and abroad. At present, ELISA method which can detect serum galactomannan is a new auxiliary diagnosis of IPA, It is being concerned gradually as a higher sensitivity and specificity method using for guiding clinical anti-aspergillus treatment. GM method is the most promising, referred to as non-traditional dianosis, in improving the level of the early detection, guiding anti-aspergillus treatment and further evaluating the value of treatment for us to improve prognosis and decrease the mortality rate.Clinical data and methods:In this article, we retrospected 45 IPA patients from September 2010 to December. Discussing their clinical feature, comparing traditional methods with non-traditional methods for diagnosing IPA from the following aspects:clinical symptom and sign,laboratory and iconography examination, microbiological examination and pathology examination, serum galactomannan detection, treatment effect.Results:Through the retrospective analysis of 45 cases clinical data, we make out that 0.5 for GM detection is the most optimal result and the sensitivity and specificity of GM(cut-off of 0.5)were 77.8%,90.0%, respectively. Compared with conventional detection methods, GM detection possesses characteristics of more convenience, more handy, higher sensitivity and higher specificity etc.; The mortality rate can be reduced to 7.7%(1/13) when the preemptive anti-aspergillus therapy of voriconazole or itraconazole were administrated according to positive results of GM(cutoff 0.5)and a progressive reduction of GM level was found both in survivors and in dead patient after systemic anti-aspergillus treatment. Analyzing patients with pulmonary diseases and patients with both pulmonary diseases and extra-pulmonary diseases, the latter are more liable to suffer from IPA and the statistical discrepancies are significant (P<0.05).Conclusion:Through the retrospective analysis of 45cases clinical data, we make conclusions that:1. GM detection have advantages in characteristics of more convenience, more handy, higher sensitivity and higher specificity etc. comparing with conventional detection methods. GM which is detected for diagnosing IPA will multiply diagnostic rate greatly and have far-reaching clinical significance associating with other methods-micrography, sputum culture and iconography.2.0.5 for GM detection plays a important role in improving the level of the early detection,guiding anti-aspergillus treatment and further evaluating the value of treatment for us to improve prognosis and decrease the mortality rate.3. Serum galactomannan should be dynamically detected for patients of IPA during their anti-aspergillus treatment courses. The medical personnel should also observe the overall trend of GM level, because consecutive qualitative of GM level is more of value than quantitative of GM for evaluating treatment.