Objective To evaluate the value of PCR analysis of blood samples in diagnosing invasive aspergillosis( IA) during antifungal therapy. Methods IA in blood and bronchoalveolar lavage fluids and/or tissue specimens was detected by PCR in 86 patients whith fungal pneumonia and underwent antifungal therapy. On the basis of EORTC/MSG criteria, the patients were divided into three groups of A(confirmed),B(clinically diagnosed) and C(suspectable) and the PCR results were compared among three groups. Results A total of 496 whole-blood samples,37 fine-needle aspirations or tissue biopsy specimens and 53 tracheal secretions was analyzed using PCR The sensitivities of whole-blood samples and bronchoalveolar lavage fluids and/or tissue specimens in group A were 61.5% and 66. 7%, respectively, which in group B were 51.8% and 57. l%,and in group C were 55. 0% and 45. 0%,respectively. The specificity was 100% in three groups. The mortalities in positive and negative patients in group A were 63.0% and 41. 0%,respectively. Conclusion The benefits of PCR diagnosis are limited during antifungal therapy. Aspergillus PCR is recommended to be performed as an adjutant manner to the microscopic examination and culture technique.%目的 评估抗真菌治疗期间,全血曲霉菌PCR方法检测侵袭性曲霉菌感染(IA)的价值.方法 入选86例真菌性肺炎而接受抗真菌治疗的血液病患者.IA感染通过血液样本、支气管肺泡灌洗液和组织样本,经过细菌培养、组织病理学检测及PCR测定进行确认.依据欧洲癌症研究治疗组织真菌病研究组(EORTC/MSG)标准,将患者分为确诊、临床诊断和拟诊三组,比较全血样本和支气管肺泡灌洗液或组织样本的PCR结果.结果 86例患者496个血液样本,37个针吸或组织活检样本和53个支气管肺泡灌洗或气管分泌物样本.PCR测定在血液样本和支气管肺泡灌洗或组织样本中的灵敏度在确诊组分别为61.5％和66.7％,临床诊断组分别为51.8％和57.1％,拟诊组分别为55.0％和45.0％.特异度均为100％.确诊组PCR阳性和阴性的患者中,病死率分别为63.0％和41.0％.结论 在抗菌治疗后不适宜进行PCR测定.曲霉菌PCR测定应推荐为显微镜观察和真菌培养的辅助检测手段.
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