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邓劲, 吴思颖, 刘雅等. 支气管肺泡灌洗液半乳甘露聚糖试验对侵袭性肺曲霉菌病的诊断价值[J]. 四川大学学报(医学版), 2018, 49(1): 124-128.
引用本文: 邓劲, 吴思颖, 刘雅等. 支气管肺泡灌洗液半乳甘露聚糖试验对侵袭性肺曲霉菌病的诊断价值[J]. 四川大学学报(医学版), 2018, 49(1): 124-128.
DENG Jin, WU Si-ying, LIU Ya. et al. Galactomannan Tests of Bronchoalveolar Lavage Fluid for Diagnosing Invasive Pulmonary Aspergillosis[J]. Journal of Sichuan University (Medical Sciences), 2018, 49(1): 124-128.
Citation: DENG Jin, WU Si-ying, LIU Ya. et al. Galactomannan Tests of Bronchoalveolar Lavage Fluid for Diagnosing Invasive Pulmonary Aspergillosis[J]. Journal of Sichuan University (Medical Sciences), 2018, 49(1): 124-128.

支气管肺泡灌洗液半乳甘露聚糖试验对侵袭性肺曲霉菌病的诊断价值

Galactomannan Tests of Bronchoalveolar Lavage Fluid for Diagnosing Invasive Pulmonary Aspergillosis

  • 摘要: 目的 评价支气管肺泡灌洗液(BALF)半乳甘露聚糖(GM)质量浓度对侵袭性肺曲霉病的诊断价值。方法 参照欧洲癌症研究和治疗组织/侵袭性真菌感染协作组(EORTC/IFICG)和美国真菌病研究组(MSG)标准、美国感染病学会(IDSA)指南,将我校华西医院295例高危感染侵袭性肺曲霉病(IPA)患者分为IPA确诊组(42例)、临床诊断组(68例)、拟诊组(61例)和排除组(124例)。采用酶联免疫吸附法试剂盒检测患者BALF中GM质量浓度(BALF GM试验)、血清中GM的质量浓度(血清GM试验),以临床确诊和临床诊断侵袭性肺真菌感染(invasive pulmonary fungal infection,IPFI)为金标准(+),以排除为金标准(-),以GM试验中GM值≥拟定的GM阈值为诊断性试验阳性,并绘制受试者工作特征曲线(ROC曲线),了解BALF GM检测在不同阈值下对IPFI的诊断效率,以约登指数最大确定本研究BALF GM的最佳诊断点。结果 以BALF GM结果做ROC曲线,曲线下面积为0.932,当BALF GM值为1.5 ng/mL时,以此为最值诊断点,其敏感性为87.5%,特异性96.7%,阳性预测值为87.5%,阴性预测值为96.7%。BALF GM值和血清GM值均为确诊组>临床诊断组>排除组,差异有统计学意义(P<0.05);血清GM阈值以0.5 ng/mL为临界值,BALF的GM阈值以1.5 ng/mL为临界值,计算阳性率,发现BALF GM在确诊组、临床诊断组的阳性率高于血清组(P<0.05);并且血清GM中存在较高的假阳性及假阴性。结论 测定BALF的GM浓度具有快速、准确、高灵敏度和特异性的优点,有助于IPA的早期诊断。

     

    Abstract: Objective To determine the value of galactomannan (GM) in bronchoalveolar lavage fluid (BALF) for diagnosing invasive pulmonary aspergillosis. Methods According to the European Organization for Research and Treatment of Cancer / Invasive Fungal Infection Group (EORTC / IFICG) and the American Mycosis Research Group (MSG), and the American College of Infectious Diseases (IDSA) guidelines, 295 patients with pulmonary aspergillosis (IPA) and high risk of invasive infections were divided into four groups: IPA group (42 cases), clinically diagnosed group (68 cases), suspected group (61 cases), and non-IPA group (124 cases). Their serum and BALF concentrations of GM were detected by enzyme-linked immunosorbent assay (ELISA).The clinically diagnosed and confirmed invasive pulmonary fungal infections (IPFI) were treated as golden standards (+). A GM value ≥ proposed threshold was deemed diagnostic test positive. Receiver operating characteristic (ROC) curves were drawn to determine the diagnostic efficiency of BALF GM assay for IPFI. The optimal cut-off point of BALF GM was determined using Youden index. Results BALF GM had an area under the curve (AUC) of 0.932 in diagnosing IPFI, with 87.5% sensitivity,96.7% specificity, 87.5% positive predictive value, and 96.7% negative predictive value when the BALF GM value was set at 1.5 ng/mL as the optimal cut-off point. Higher BALF and serum GM values were found in the confirmed IPA group, followed by the clinical diagnosed group compared with the non-IPA group (P<0.05). The threshold value was set at 0.5 ng/mL for serum GM and 1.5 ng/mL for bronchoalveolar lavage GM. Higher positive rates were found in the confirmed IPA group and the clinical diagnosed group compared with the non-IPA group (P<0.05). Serum GM appeared to have higher false positives and false negative rates. Conclusion BALF GM is a rapid and accurate indicator with high sensitivity and specificity for the early diagnosis of IPA.

     

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