尿样中MP1P抗原检测可提高马尔尼菲塔氏芳香菌病的快速筛查和诊断

IF 2.2 4区医学 Q3 MYCOLOGY

Journal de mycologie medicale Pub Date : 2025-04-29 DOI:10.1016/j.mycmed.2025.101553

Yeyang Zhang , Pengle Guo , Yaozu He , Qinzhi Zhang , Longping Yang , Yingchun Ke , Yu Meng , Feilong Xu , Xiaopin Tang , Linghua Li

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引用次数: 0

摘要

研究背景：我们对尿中的曼尼菲Talaromyces marneffei甘露蛋白（Mp1p）抗原进行检测，以期为早期治疗和降低死亡率创造一种实用、快速的诊断工具。本前瞻性横断面研究评估了2022年3月至2023年1月在广州第八人民医院登记的215例艾滋病患者尿液样本中Mp1p检测的敏感性和特异性，采用ELISA和荧光免疫层析（FIC）。在塔拉芳香菌病组和非塔拉芳香菌病组中，大多数患者为男性，分别占82.5%和88.6%。talaromyosis组的中位年龄为42岁，而非talaromyosis组的中位年龄为48岁。所有患者均为hiv感染，塔香菌病患者CD4+ T细胞中位数为47个细胞/μL，非塔香菌病患者为187个细胞/μL。ELISA检测尿液中Mp1p抗原的灵敏度最高（77.5%,95% CI: 61.5 ~ 89.2%），特异性最高（97.1%,95% CI: 93.5 ~ 99.1%）。阳性预测值（PPV）为79.5%(31/39)，阴性预测值（NPV）为94.9% (167/176)，kappa系数为0.739。曲线下面积（Area Under The Curve， AUC）鉴别talaromyosis患者的准确率为85.8% （95% CI, 76.9 - 94.9%）。FIC患者尿液中Mp1p抗原（Ag）的敏感性、特异性、PPV、NPV、kappa值分别为67.5% （95% CI: 50.9 ~ 81.4%）、94.9% （95% CI: 90.5 ~ 97.6%）、75%（27/36）、92.7%（166/179）、0.649。尿液Mp1p Ag ELISA与血清Mp1p Ag FIC联合检测特异性最高（96%），PPV最高（82.1%），kappa值最高（0.767）。相比之下，尿液Mp1p Ag ELISA和血清GM Ag配对的灵敏度最高（92.5%），NPV最高（98.1%）。结论尿液中Mp1p抗原（Ag）的鉴定已被证明是鉴别艾滋病患者合并感染的可靠方法，可作为临床早期检测的辅助工具。

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MP1P antigen detection in urine samples could improve the rapid screening and diagnosis of talaromycosis marneffei

Background

We evaluated Talaromyces marneffei mannoprotein (Mp1p) antigen in urine to create a practical, rapid diagnostic tool for early treatment and reduced mortality.

Methodology/Principal Findings

This prospective cross-sectional study assessed the sensitivity and specificity of Mp1p detection in urine samples from 215 AIDS patients at Guangzhou Eighth People's Hospital, enrolled between March 2022 and January 2023, using ELISA and fluorescence immunochromatography (FIC). In both the Talaromycosis and non-talaromycosis groups, most patients were male, comprising 82.5 % and 88.6 %, respectively. The median age was 42 years for the talaromycosis group and 48 years for the non-talaromycosis group. All patients were HIV-infected, with median CD4+ T cell counts of 47 cells/μL for talaromycosis and 187 cells/μL for non-talaromycosis. Among detection methods, ELISA showed the highest sensitivity (77.5 %, 95 % CI: 61.5–89.2 %) and specificity (97.1 %, 95 % CI: 93.5–99.1 %) for the Mp1p antigen in urine. The Positive Predictive Value (PPV), Negative Predictive Value (NPV), and kappa coefficient were 79.5 % (31/39), 94.9 % (167/176), and 0.739, respectively. The Area Under the Curve (AUC) accuracy for distinguishing patients with talaromycosis was 85.8 % (95 % CI, 76.9–94.9 %). The sensitivity, specificity, PPV, NPV, and kappa value of the Mp1p antigen (Ag) in urine following FIC were 67.5 % (95 % CI: 50.9–81.4 %), 94.9 % (95 % CI: 90.5–97.6 %), 75 % (27/36), 92.7 % (166/179), and 0.649, respectively. Combining urine Mp1p Ag ELISA with serum Mp1p Ag FIC achieved the highest specificity (96 %), PPV (82.1 %), and kappa value (0.767). In contrast, the urine Mp1p Ag ELISA and serum GM Ag pairing showed the highest sensitivity (92.5 %) and NPV (98.1 %).

Conclusions

Identification of the Mp1p antigen (Ag) in urine has been shown to be a reliable method for differentiating coinfections in AIDS patients, serving as a supplementary tool for early detection in clinical settings.

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来源期刊

Journal de mycologie medicale 医学-真菌学

CiteScore

5.10

自引率

2.80%

发文量

审稿时长

6-12 weeks

期刊介绍： The Journal de Mycologie Medicale / Journal of Medical Mycology (JMM) publishes in English works dealing with human and animal mycology. The subjects treated are focused in particular on clinical, diagnostic, epidemiological, immunological, medical, pathological, preventive or therapeutic aspects of mycoses. Also covered are basic aspects linked primarily with morphology (electronic and photonic microscopy), physiology, biochemistry, cellular and molecular biology, immunochemistry, genetics, taxonomy or phylogeny of pathogenic or opportunistic fungi and actinomycetes in humans or animals. Studies of natural products showing inhibitory activity against pathogenic fungi cannot be considered without chemical characterization and identification of the compounds responsible for the inhibitory activity. JMM publishes (guest) editorials, original articles, reviews (and minireviews), case reports, technical notes, letters to the editor and information. Only clinical cases with real originality (new species, new clinical present action, new geographical localization, etc.), and fully documented (identification methods, results, etc.), will be considered. Under no circumstances does the journal guarantee publication before the editorial board makes its final decision. The journal is indexed in the main international databases and is accessible worldwide through the ScienceDirect and ClinicalKey platforms.