The clinical significance of G-test, GM test, and three fungal antigens in screening for fungal infections in newly diagnosed HIV patients
G试验、GM试验及三种真菌抗原对初治HIV患者合并真菌感染筛查的临床意义

摘要

目的 分析初步真菌筛查对初治HIV患者合并真菌感染临床诊断的指导意义。方法 回顾性收集临汾市第三人民医院2023—2024年住院治疗的初治HIV患者真菌筛查结果，分析其对HIV/AIDS不同CD4+T淋巴细胞水平的阳性率，结合临床表现，评估其临床辅助意义。结果 在106名HIV初治患者中，CD4≤50个μL/者G试验阳性率41.51%，CD4≤100个/μL者念珠菌抗原阳性率41.43%，CD4≤200个/μL者隐球菌荚膜抗原阳性率13.1%；临床诊断中，CD4≤200个/μL者口腔黏膜和/或消化道念珠菌感染率40.48%，耶氏肺孢子菌肺炎36.9%，还有少部分新型隐球菌和马尔尼菲蓝状菌感染患者，以及念珠菌、隐球菌、马尔尼菲蓝状菌抗原血症病例。结论 在初治HIV住院患者中进行真菌初步筛查，血液中G试验和念珠菌抗原阳性率较高、隐球菌抗原和马尔尼菲蓝状菌抗原阳性率也占一定比率，血液筛查对HIV患者临床真菌感染的及早诊治有重要意义。真菌确诊较为困难或时间过长，针对性治疗过晚。为提高HIV/AIDS治疗有效率，降低其病死率，对CD4水平低于200个/μL者，应积极进行真菌筛查，结合临床，及早诊治，对基层临床工作有大的科学指导意义。

Abstract

Objective To analyze the guiding significance of preliminary fungal screening for the clinical diagnosis of newly treated HIV patients with fungal infection.
Methods A retrospective collection was conducted on the fungal screening results of newly diagnosed HIV patients admitted to the Third People's Hospital of Linfen City from 2023 to 2024. The positive rates of different CD4+T lymphocyte levels in HIV/AIDS patients were analyzed, and their clinical significance was evaluated based on clinical manifestations.
Results Among 106 newly diagnosed HIV patients, the G test positivity rate was 41.51% for CD4≤50μL, 41.43% for Candida antigen positivity rate for CD4≤100μL, and 13.1% for Cryptococcus capsule antigen positivity rate for CD4≤200μL; In clinical diagnosis, the infection rate of oral mucosa and/or digestive tract Candida in patients with CD4≤200 cells/μL is 40.48%, PCP is 36.9%, and there are also a small number of patients infected with Cryptococcus neoformans and penicillium marneffei, as well as cases of Candida, Cryptococcus, and penicillium marneffei antigenemia.
Conclusion   In the initial screening of fungal infections in hospitalized patients with newly diagnosed HIV/AIDS, the positive rates of G test and Candida antigen in blood are relatively high, and the positive rates of Cryptococcus antigen and penicillium marneffei antigen also account for a certain proportion. Blood screening is of great significance for the early diagnosis and treatment of fungal infections in HIV patients. Fungal diagnosis is difficult or takes too long, and targeted treatment is too late. In order to improve the effectiveness of HIV/AIDS treatment and reduce its mortality rate, active fungal screening should be carried out for individuals with CD4 levels below 200/μL, combined with clinical practice for early diagnosis and treatment, which has great scientific guidance significance for grassroots clinical work.