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| 四种不同检测方法在HIV合并隐球菌脑膜炎中的诊断价值 |
| Diagnostic value of four different detection methods in HIV associated cryptococcal meningitis |
| 投稿时间：2023-06-14 修订日期：2024-04-08 |
| DOI： |
| 中文关键词: 艾滋病 隐球菌脑膜炎 脑脊液 诊断 |
| 英文关键词: HIV, CM, CSF, Diagnosis |
| 基金项目:2020年湖北省重点研发计划项目（No. 2020BCB025）；武汉大学中南医院学科培育项目（No. ZNXKPY2021021） |
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| 中文摘要: |
| [摘要]：目的 探讨在脑脊液（cerebro-spinal fluid, CSF）样本中隐球菌荚膜抗原（cryptococcal antigen, CrAg）胶体金免疫层析法、墨汁染色法、真菌培养法以及病原宏基因二代测序（next-generation sequencing,NGS）在HIV合并隐球菌脑膜炎(cryptococcal meningitis, CM) 疾病中的诊断价值。方法 回顾性分析2020年12月-2022年12月武汉大学中南医院感染科171例考虑中枢神经系统感染行腰椎穿刺进行隐球菌检测的住院患者的临床资料，并收集HIV合并隐球菌脑膜炎患者的一般资料、临床表现、隐球菌相关实验室检测结果，比较四种检测方法对HIV合并隐球菌脑膜炎的检测阳性率、灵敏度和特异度。结果 171例研究对象中最终诊断为HIV合并隐球菌脑膜炎的患者共35例，HIV合并隐球菌患者以神经系统受累，伴发热头晕头痛为主要表现。171份脑脊液样本中，隐球菌荚膜抗原检测阳性率为18.9%，墨汁染色阳性率为15.4%，真菌培养阳性率为10.7%，NGS阳性率为23.3%。隐球菌荚膜抗原检测、墨汁染色、培养法、NGS灵敏度分别为97.0%、75.8%、52.9%和100.0%，特异度分别为100.0%、99.2%、100.0%和100.0%。各检测方法脑脊液送检至报告的平均时间分别为0.5天、0.5-1天、5天和2天。10例患者NGS检测结果发现同时有3种及以上病原菌多重感染的患者高达70%（7/10）。 结论 对于行腰椎穿刺患者而言，脑脊液样本的墨汁染色镜检可以早期筛查获得病原学诊断依据，真菌培养是诊断金标准且有后续药敏试验检测需要，隐球菌抗原检测和NGS检测灵敏度和特异度都高，检测报告时间短，且NGS可用于HIV合并多重感染患者的早期病原学诊断。因此，建议尽量联合多方法同时检测，为HIV合并隐球菌脑膜炎的临床诊断提供更准确更快速的临床证据，为患者争取更大获益。 |
| 英文摘要: |
| [Abstract]：Objective To explore the diagnostic value of cryptococcal antigen（CrAg）, India ink staining, fungal culture, and next-generation sequencing (NGS) of in cerebrospinal fluid (CSF) samples in HIV associated cryptococcal meningitis (CM) . Method A retrospective analysis was conducted on the clinical data of 171 hospitalized patients with central nervous system infection who underwent lumbar puncture for cryptococcal testing in Department of Infectious Diseases,?Zhongnan Hospital of Wuhan University from December 2020 to December 2022. General information, clinical manifestations, and laboratory test results of HIV associated CM patients were collected, and the positive rate, sensitivity, and specificity of the four detection methods for HIV associated CM were compared. Results Among the 171 study subjects, a total of 35 patients were ultimately diagnosed with HIV associated CM. The main manifestations of HIV associated CM patients were neurological involvement, accompanied by fever, dizziness, and headache. Among 171 cerebrospinal fluid samples, the positive rate of CrAg detection was 18.9%, ink staining was 15.4%, fungal culture was 10.7%, and NGS was 23.3%. The sensitivity of the CrAg detection, ink staining, fungal culture , and NGS were 97.0%, 75.8%, 52.9% and 100.0%, respectively, and the specificity were 100.0%, 99.2%, 100.0% and 100.0%, respectively. The average reported time is 0.5 days, 0.5-1 days, 5 days and 2 days, respectively. The NGS test results of 10 patients showed that up to 70% (7/10) of patients had multiple infections of three or more pathogenic bacteria simultaneously.Conclusion For patients undergoing lumbar puncture, ink staining of CSF samples can provide early screening for pathogenic diagnosis. Fungal culture is the gold standard for diagnosis and there is a need for subsequent drug sensitivity testing，and cryptococcus antigen detection and NGS have high sensitivity and specificity, and the detection report time is short. NGS can be used for early pathogenic diagnosis of HIV patients with multiple infections. Therefore, it is recommended to combine multiple methods for simultaneous testing as much as possible to provide more accurate and rapid clinical evidence for the diagnosis of HIV associated CM, and to strive for greater benefits for patients. |
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