血清和支气管肺泡灌洗液隐球菌抗原-胶体金免疫层析法检测在肺隐球菌病中的诊断价值

Diagnostic value of serum and bronchoalveolar lavage fluid cryptococcal antigen-colloidal gold immunochromatography in pulmonary cryptococcal disease

目的探讨血清与支气管肺泡灌洗液隐球菌抗原-胶体金免疫层析法(CrAg-LFA)两种方法在肺隐球菌病患者诊断中的效能。方法选取抚州市第一人民医院2020年1月至2023年1月收治的60例疑似肺隐球菌病患者为研究对象,所有患者均经血清、支气管肺泡灌洗液CrAg-LFA及肺穿刺组织病理学检查,将肺穿刺组织病理结果作为金标准,比较血清、支气管肺泡灌洗液CrAg-LFA在肺隐球菌病患者中的诊断效能。结果60例疑似肺隐球菌病经肺穿刺组织确诊51例,阳性率为85.00%。血清CrAg-LFA的灵敏度、特异度、准确度分别为72.55%、66.67%、71.67%,与金标准的一致性较差(Kappa=0.261,P=0.021);肺泡灌洗液CrAg-LFA的灵敏度、特异度、准确度分别为94.12%、88.89%、93.33%,与金标准的一致性较好(Kappa=0.760,P<0.001)。肺泡灌洗液CrAg-LFA灵敏度、阴性预测值、准确度均高于血清CrAg-LFA检测,差异有统计学意义(P<0.05),两种方法的特异度、阳性预测值比较,差异无统计学意义(P>0.05)。结论肺泡灌洗液CrAg-LFA诊断肺隐球菌病的效能较血清CrAg-LFA诊断理想,其与肺穿刺组织病理诊断结果一致性更高,临床针对高度疑似肺隐球菌病患者,首先考虑采取肺泡灌洗液CrAg-LFA检查,可减少临床漏诊与误诊的发生情况。

Objective To explore the efficacy analysis of serum and bronchoalveolar lavage fluid cryptococcal antigen colloidal gold immunochromatography(CrAg-LFA)in the diagnosis of pulmonary cryptococcosis patients.Methods Sixty patients with suspected pulmonary cryptococcosis treated in Fuzhou First People's Hospital from January 2020 to January 2023 were selected as the study objects.All patients were examined by serum,bronchoalveolar lavage fluid CrAg-LFA and lung puncture histopathology.The pathological results of lung puncture tissue were used as the gold standard to compare the diagnostic efficacy of serum and bronchoalveolar lavage fluid CrAg-LFA in patients with pulmonary cryptococcosis.Results Of 60 suspected pulmonary cryptococcosis,51 cases were confirmed by lung puncture tissue,positive rate was 85.00%.The sensitivity,specificity and accuracy of CrAg-LFA were 72.55%,66.67%and 71.67%,respectively,and the consistency with gold standard was poor(Kappa=0.261,P=0.021).The sensitivity,specificity and accuracy of CrAg-LFA were 94.12%,88.89%and 93.33%,respectively,which were in good agreement with the gold standard(Kappa=0.760,P<0.001).The sensitivity,negative predictive value,and accuracy of CrAg-LFA in alveolar lavage fluid were higher than those in serum CrAg-LFA detection,with statistical significances(P<0.05),while there were no statistical significances in specificity,positive predictive value between the two methods(P>0.05).Conclusion The diagnostic efficacy of alveolar lavage fluid CrAg-LFA for pulmonary cryptococcosis is ideal compared to serum CrAg-LFA,and it has higher consistency with the pathological diagnosis results of lung puncture tissue.For highly suspected pulmonary cryptococcosis patients,the first consideration is to use alveolar lavage fluid CrAg-LFA examination to reduce the occurrence of clinical missed diagnosis and misdiagnosis.