【摘要】：近年來(lái),由于各種醫(yī)源性因素如廣譜抗生素、皮質(zhì)類(lèi)固醇激素、免疫抑制劑以及抗腫瘤藥物等的廣泛使用,器官移植及各種導(dǎo)管介入手術(shù)的開(kāi)展,導(dǎo)致機(jī)會(huì)性深部真菌感染的發(fā)病率明顯增高。曲霉菌躍居第二已成為僅次于念珠菌的重要致病性真菌,由曲霉感染引起的侵襲性曲霉病(IA),嚴(yán)重威脅患者的生命,死亡率高達(dá)80%甚至到100%,其中煙曲霉感染引起的IA占總IA的90%以上。臨床研究表明,IA的早期診斷與預(yù)后關(guān)系密切。但由于曲霉感染發(fā)病隱匿,臨床表現(xiàn)缺乏特征性,早期診斷十分困難。血培養(yǎng)、組織活檢為曲霉感染實(shí)驗(yàn)室診斷的金標(biāo)準(zhǔn),但培養(yǎng)時(shí)間長(zhǎng)、陽(yáng)性率低、操作污染導(dǎo)致的假陽(yáng)性及組織活檢的局限性和創(chuàng)傷性,已不能滿(mǎn)足臨床的需要。目前,血清學(xué)和分子生物學(xué)研究已成為人們的關(guān)注點(diǎn),PCR技術(shù)在早期感染即可檢測(cè)到微量的真菌DNA,且可以鑒定到種,對(duì)指導(dǎo)臨床用藥有一定幫助。但在引物設(shè)計(jì)、臨床標(biāo)本的防污染處理,結(jié)果的判斷等對(duì)實(shí)驗(yàn)室和操作人員的要求很高,國(guó)內(nèi)外仍停留在小樣本的研究。而血清抗體的檢測(cè)受限于患者本身在嚴(yán)重免疫抑制狀態(tài)下,無(wú)法產(chǎn)生足夠的抗體。而且由于煙曲霉孢子漂浮于空氣中,幾乎每個(gè)健康成人血清中均存在煙曲霉抗體。因此,抗體不能用于早期、特異性的檢測(cè)。真菌抗原的檢測(cè)也是目前研究的熱點(diǎn)。研究顯示,從煙曲霉的提取物中目前至少發(fā)現(xiàn)100多種抗原性分子,約有12種被純化成單一抗原形式。已經(jīng)證實(shí)煙曲霉細(xì)胞壁上豐富的半乳糖甘露聚糖(galactomannan GM)是煙曲霉的主要抗原成分,
[Abstract]:In recent years, due to the extensive use of various iatrogenic factors such as broad-spectrum antibiotics, corticosteroids, immunosuppressants and anti-tumor drugs, organ transplantation and various catheter intervention operations have been carried out. The incidence of opportunistic deep fungal infection was significantly increased. Aspergillus has become the second most important pathogenic fungus after candida. The invasive aspergillosis (IA),) caused by aspergillus infection is a serious threat to the life of patients. Mortality was as high as 80% to 100%, of which IA caused by Aspergillus fumigatus accounted for more than 90% of the total IA. Clinical studies have shown that early diagnosis of IA is closely related to prognosis. However, the early diagnosis of aspergillus infection is very difficult because of its hidden incidence and lack of characteristic clinical manifestations. Blood culture and tissue biopsy are the gold standard for laboratory diagnosis of aspergillus infection, but the culture time is long, the positive rate is low, the false positive caused by operation contamination and the limitation and trauma of tissue biopsy can not meet the clinical needs. At present, serology and molecular biology research have become the focus of attention. PCR technology can detect trace fungal DNA in early infection, and can identify species, which is helpful to guide clinical drug use. However, primer design, anti-contamination treatment of clinical specimens and judgment of results are very demanding for laboratory and operator, and they are still in the research of small samples at home and abroad. The detection of serum antibodies is limited by the fact that the patients themselves are unable to produce enough antibodies under severe immunosuppressive conditions. And because Aspergillus fumigatus spores float in the air, almost every healthy adult serum contains Aspergillus fumigatus antibody. Therefore, antibodies cannot be used for early, specific detection. The detection of fungal antigens is also a hot topic at present. Studies show that at least 100 antigenic molecules have been found from the extracts of Aspergillus fumigatus and about 12 of them have been purified into a single antigen form. It has been proved that the abundant galactosmannan (galactomannan GM) on the cell wall of Aspergillus fumigatus is the main antigen of Aspergillus fumigatus.
【學(xué)位授予單位】：第一軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2005
【分類(lèi)號(hào)】：R392

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