The Significance Of G/GM Test In Evaluating The Efficacy Of Antifungal Agents

BackgroundInvasive fungal disease(IFD)is a disease in which the fungus invades the human body,which grows in the tissues,organs or blood,body fluids,secretions,and causes inflammation and tissue damage.The diagnosis of IFD depends on the involved tissue biopsy or humoral cultures revealed fungal cells and(or)pseudohypha,hyphae or spherical body,or fungal growth in the blood culture or positive fungal specific antigen in cerebrospinal fluid.Due to the incompetent immunity of malignant blood disease,and the application of chemotherapy,hormone and immunosuppressive agents,and long-term use of broad spectrum antibiotics,the incidence of IFD is recently increased.The patients treated with antifungal agents usually experienced long-term course,high cost,severe side effects,limited response and high mortality rate of [1,2].Therefore,it is necessary to identify the efficacy of antifungal agents in clinical practice,in order to guide the modification of antifungal agents application.ObjectiveTo investigate the relationship between the dynamic change of G/GM test and the efficacy of antifungal agents in the treatment of invasive fungal disease in hematological malignancies with.Materials and methodsData were retrospectively collected from 113 cases of malignant hematological disease complicated with fungal infection in the Department of Hematology of the First Affiliated Hospital of Zhengzhou University from January 2015 to January 2016.More than twice of the G/GM were tested in 90 cases and only one G/GM test were perform in 23 cases.All of the casese were divided into effective group and ineffective group according to the response of antifungal treatment including symptoms and signs,imaging changes and microbial evidences.All the data were retrospectively analyzed if patients were evaluated for G/GM test at the first(d1),7(d7),14(d14),21(d21),28(d28)days.The relationship between G/GM value and the efficacy of antifungal treatment were analyzed.SPSS software was used to analyze data.The quantitative data of normal distribution: t test or calibration test of T,described by X + SD;qualitative data: 2 chi square test or Fisher exact test;quantitative data of non normal distribution: the rank sum test,M(P25 ~P75);inspection standards for a=0.05.In p< 0.05 was statistically significant.Results1.The disease distribution: There were 113 cases of patients with hematological diseases including59 cases of AML(M0:2 cases,M1:1 cases,M2:30 cases,M3:3 cases,M4:6 cases,M5:16 cases,M6:1 cases)and26 cases of ALL(ALL-B:17 cases,ALL-T:9 cases),5 cases of CML,6 cases of MM,3 cases of MDS,and 14 cases of others.The the IFD cases were diagnosed as diagnosis(1 case),clinical diagnosis(65 cases),possible diagnosis(26 cases)and unidentified(21 cases).Before the use of antifungal agents,G test was higher than normal in 57 cases and the normal range in 56 cases;while the GM test was higher than normal in 68 cases and the normal range in 45 cases.2.After antifungal therapy,86 out of 113 cases(76.1%)were response,27 cases(23.9%)were not response.Seventeen out of 18 cases performed once G test were response(94.4%),twentieight out of 31 cases(90.3%)performed twice G test were response,and 41 out of 64 cases(64.1%)monitored more than 3 times of the G test were response.There was statistical significance between cases monitored G test 1 time and ?3 times(?2=6.26,p < 0.05),and that between cases monitored G test 2 times and ?3 times(?2=7.24,p < 0.05).There was no statistically significance between cases monitored G test 1 time and 2 times(?2=0.00,p > 0.05).20 out of 22 cases performed once GM test were response(90.9%),33 out of 37 cases(89.2%)performed twice GM test were response,and 33 out of 54cases(61.1%)monitored more than 3 times of the GM test were response.There was statistical significance between cases monitored GM test 1 time and ?3 times(?2=6.45,p < 0.05),and that between cases monitored GM test 2 times and ?3 times(?2=8.68,p < 0.05).There was no statistically significance between cases monitored GM test 1 time and 2 times(?2=0.05,p > 0.05)3.The cases with G test to be negative at d28 in response group were more than that in non-response group(86.4% vs 50%;?2=4.84,p=0.028).The cases with GM test to be negative at d21 in response group were more than that in non-response group(90.9% vs 61.5%;?2=4.41,p=0.038).The cases with GM test to be negative at d28 in response group were more than that in non-response group(100% vs 69.2%;?2=9.12,p=0.003).The cases with GM test to be negative at d7,d14,d21 were no statistically significance between response group and non-response group.The cases with GM test to be negative at d7,d14 were no statistically significance between response group and non-response group.4.In the 64 cases mornitored G test ?3 times,the therapeutic response were observed in 41 cases,including 31 cases with the values of G tests declined,10 cases stable or increased.The therapeutic non-response were observed in 23 cases including 10 cases with the values of G tests declined and 13 cases stable or increase.The cases with G test to be declined in response group were more than that in non-response group(?2 =6.6,p < 0.05);In the 54 cases mornitored GM test ?3 times,the therapeutic response were observed in 33 cases,including 25 cases with the values of GM tests declined,8 cases stable or increased.The therapeutic non-response were observed in 21 cases including 10 cases with the values of GM tests declined and 11 cases stable or increase.The cases with GM test to be declined in response group were more than that in non-response group(?2 =4.6,p < 0.05);G/GM remained at a high level when patients received antifungal therapy ineffective.5.The average age were 34 years(14 ~73 years old)in response group and 44.7 years(16~58 years)in non-response group.The difference had no statistic significance(p=0.083).The average time of hospitalization in response group was 20.5 days(7 days ~55 days)and 32.6 days(15 ~70 days)in non-response group(T=2559,p=0.000).The hospitalization time were longer in non-reponse group than that in response group.ConclusionIFD patients after antifungal therapy,G/GM showed a decreasing trend,the cases with stabe or increase values of G/GM test or in sustained high level of G/GM test indicate poor reponse to antifungal treatment.In the cases with therapeutic response,the G test usually become negative by antifungal therapy for 28 days and GM test by 21 and 28 days.