Comparison Of β-galactomannan And IgG Antibody Testing In Aspergillosis

Object:In recent years,with the widespread use of broad-spectrum antibiotics and immunosuppressants,the infection rate of invasive fungal disease（IFD）has been increasing year by year.According to epidemiological statistics,there are approximately 200,000 Aspergillus infection patients each year.The mortality rate may even be up to30%-90%^[1].Invasive fungal disease can infect multiple organs,especially lung infection,so invasive pulmonary aspergillosis is currently the most common invasive aspergillosis（IA）.Because of its high risk factors,there is no obvious clinical features of onset,and always covered by other underlying diseases,because of lack of specific diagnostic methods.Although pathology is the gold standard,most patients and their families do not accept their invasiveness.Therefore,we need to find an early detection method with high specificity and few interference factors.In recent years,theβ-galactomannan testing（GM）has been highly valued at home and abroad and has been widely used in clinical practice.However,we found that this method has some interference factors in the detection process,and does not apply to all groups.At present,there are more and more researches on IgG antibodies in Aspergillosis in foreign countries.Through the analysis of the risk factors of Aspergillus infection,the statistical significance of IgG antibodies in the diagnosis of Aspergillosis and the diagnosis of GM and IgG antibodies in Aspergillus infections.With regard to the effects of treatment and prognosis,we can intervene early on Aspergillus infection to improve the prognosis,and there is a better prospect for the treatment of Aspergillus infection.Clinical data and methods:Through retrospective analysis of the clinical data of 281 patients who were diagnosed with invasive pulmonary aspergillosis from September2017 to February 2018 in the China-Japan Union Hospital of Jilin University inpatient and outpatient clinics,including:distribution departments,clinical manifestations,and imaging.The characteristics of the study,microbiological examination,results of antibody IgG testing in Aspergillosis and results ofβ-galactomannan were analyzed statistically,and the prognosis of some patients was followed.Results:The infections were mainly distributed in pneumology department（42.0%）.The basic diseases in lung were:25 cases（39%）of pneumonia,15 cases（23.4%）of respiratory failure,and 8 cases（12.5%）of chronic obstructive pulmonary disease.The main basal diseases were:20 cases（27.0%）of cardiovascular disease,16 cases（21.62%）of cerebral infarction,and type 2 diabetes in 15 cases（20.3%）.The clinical manifestations are as follows:1.48 cases（41.7%）of cough cough in.2.26 cases（22.6%）of fever.Laboratory tests:Blood routine on admission:Clinical IPA can be divided into 31 cases（36.05%）of neutrophils and 55cases（63.95%）of neutrophil deficient.The CT imaging showed:2 cases of typical lesions around the circumference of a low-density halo,1 case of crescent and low-density shadow,2 cases of pleural effusion,15 cases of interstitial lung changes and a small number of patches High-density shadows,40 cases of scattered high-density patchy high-density shadow similar to ordinary pneumonia,5 cases only see the lung texture enhancement.The patients were divided into agranulocytosis and the non-granulocyticdeficiency.Theagranulocytosis:1.GMtesting sensitivity:70%,specificity:87%,positive predictive value:61%,negative predictive value:90%,Conformity:83%.2.IgG testing:sensitivity:30%,specificity:93%,positive predictive value:58%,negative predictive value:82%,compliance:79%.Non-granular deficiency group:1.GM testing:sensitivity:22%,specificity:86%,positive predictive value:44.8%,negative predictive value:68%,compliance:64%.2.IgG testing:sensitivity:78%,specificity:90%,positive predictive value:82%,negative predictive value:89%,compliance:87%.A total of10 patients receiving conventional antifungal therapy were admitted to hospital,treatedfor7days,treatedfor90days（discontinuation）,results ofGM testing for the entire course of treatment 14 days after discontinuation,and results of IgG antibody testing:69 patients admitted to the hospital with conventional antifungal treatment were treated,The results of the 7-day experiment showed a decreasing trend,and 4 cases showed an upward trend without conventional treatment.Conclusion:1.The patients with pulmonary aspergillosis in our hospital were concentrated in the relevant departments such as respiratory department,and the underlying diseases were more complicated with pulmonary aspergillosis.In our hospital,the lung diseases were mainly pneumonia,and the extrapulmonary diseases were mainly cardiovascular diseases.There was no typical clinical manifestations.,Simple imaging and microbiological culture are more limited in the diagnosis of disease,serological detection is essential.2.In patients of agranulocytosis,the sensitivity,specificity,positive predictive value,negative predictive value,and clinical diagnostic compliance of the GM test for the diagnosis of Aspergillus infection are superior to the IgG antibody test.For non-granulocytic deficiency patients,the IgG antibody testing is better than the GM testing.Therefore,joint detection should be used as an important indicator of the diagnosis of aspergillosis.3.The results of GM and IgG antibody testing should be monitored multiple times,which will play an important role in the diagnosis,treatment and prognosis of Aspergillus infections.