半乳甘露聚醣抗原檢測偽陽性之相關因素探討:以加護病房為例之病例對照研究

Investigating Factors of False-Positive Results of Aspergillus Galactomannan Assay: A Case-Control Study in Intensive Care Units

洪于絢(Yu-Hsuan Hung)

指導教授 ： 陳崇鈺

高雄醫學大學/藥學院/藥學系碩士在職專班/碩士(2020年)

摘要

研究背景：半乳甘露聚醣抗原檢測在早期診斷侵襲性麴菌症是廣泛被使用的輔助診斷工具之一，然而不少干擾因素曾被研究可能使檢驗値呈現偽陽性，本研究目的為探討加護病房重症族群接受半乳甘露聚醣抗原檢測時是否存在對檢驗值干擾的暴露因子，以減少醫療人員對檢驗結果的疑慮。
研究方法：以病例對照研究回溯兩年間曾接受半乳甘露聚醣抗原檢測的加護病房重症病人，歸類為偽陽性或真陰性的病人以1比4分組，以卡方檢定和獨立樣本t檢定分析兩組間疾病、生理檢測數值、藥物治療和重症醫療相關處置之分布；運用條件式迴歸法分析暴露因素於兩組間呈現偽陽性的勝算比。結果以p值小於0.05為具有統計學上的顯著差異。
研究結果：共納入206位病人，包含20位(9.7%)偽陽性和配對分組後80位真陰性病人，相較於對照組，檢測呈現陽性但病人不具有明顯麴菌感染時，檢測前使用colistin吸入治療為偽陽性結果呈現最顯著的干擾因子 (OR: 35.682, 95% CI: 3.772-337.511, p = 0.002)。
結論與建議：醫療人員解釋半乳甘露聚醣抗原檢測值時仍須慎重考量是否存在干擾因子，尤其是對於曾經使用colistin吸入治療多重抗藥性肺炎的加護病房族群。

關鍵字

半乳甘露聚醣 ； 侵襲性麴菌症 ； 偽陽性 ； 加護病房

並列摘要

Background: Galactomannan assay is one of the widely used auxiliary tools in the early diagnosis of invasive aspergillosis. Many factors have been studied that may interfere with the test value, which caused false-positive. This study aimed to probe the risk factors of galactomannan assay among patients in the intensive care units, and reduce doubts of medical personnel about the inspection report.
Methods: A case-control approach was conducted to retrospect critically ill patients in the intensive care unit who had undergone galactomannan antigen testing in the past two years. The patients classified as false-positive or true-negative were divided into groups of 1:4. Chi-square test and student's t-test were used to analyze the distribution of diseases, physiological test values, medical treatments, and critical care between the two groups. Conditional regression was used to analyze the odds ratio of false-positivity among exposure. Results were statistically significant when p-value lower 0.05.
Results: 206 patients were enrolled, including 20 (9.7%) false-positives and 80 true-negatives after paired grouping. Comparing to the true-negatives, patients with positive GM test results but were incompatible with the diagnosis of invasive aspergillosis, the use of colistin inhalation before the test will significantly increase the risk of false-positive. (OR: 35.682, 95% CI: 3.772-337.511, p = 0.002).
Conclusions: Medical personnel must still carefully consider the presence of interfering factors when interpreting galactomannan antigen detection values, especially for critically ill patients who inhaled colistin for multi-drug resistant pneumonia.

並列關鍵字

galactomannan, ； invasive aspergillosis ； false-positive ； intensive care unit

參考文獻

1. Lamoth F, Calandra T. Early diagnosis of invasive mould infections and disease. J Antimicrob Chemother. 2017;72:i19-i28.

2. DePauw B, Walsh TJ, Donnelly JP, et al. Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/ MSG) Consensus Group. Clin Infect Dis. 2008;46(12):1813-1821.

3. Meersseman W, Lagrou K, Maertens J, WijngaerdenEV. Invasive Aspergillosis in the Intensive Care Unit. Clin Infect Dis. 2007;45(2):205-216.

4. Kirk PM, Cannon PF, Minter DW, Stalpers JA. Ainsworth & Bisby’s Dictionary of the Fungi. 10th Editi. Wallingford, UK: CABI; 2008.

5. ChamilosG. Aspergillus fumigatus and Aspergillosis in 2019. 2020;33(1):1-75.