BALF中GM试验对儿童IPA的诊断价值

Diagnostic value of galactomannan test in bronchoalveolar lavage fluid for invasive pulmanory aspergillosis in children

目的:评价支气管肺泡灌洗液(BALF)中半乳甘露聚糖检测(GM试验)对儿童侵袭性肺曲霉感染(IPA)的诊断价值.方法:选择中南大学湘雅三医院172例疑为IPA患儿.将诊断结果为确诊、临床诊断和拟诊的划分为IPA组,诊断结果为排除的划分为非IPA组.采用酶联免疫夹心法进行GM试验,通过绘制ROC曲线分析比较BALF GM试验和血清GM实验对IPA的诊断价值,计算BALF中GM试验和血清GM检测在以0.5、0.8、1.0为阳性临界值时的诊断效率,并确定最佳临界值.结果:结合数据分析可得,可得I=0.6时血清GM实验为IPA的最佳诊断点,I=0.8为BALFGM实验为IPA的最佳诊断点.与I=0.6时血清GM检测结果的敏感度(61.9%)和特异度(79.2%)相比,I=0.8时BALFGM实验诊断IPA的敏感性(78.0%)和特异度(73.4%)有所提高,差异有统计学意义.绘制ROC曲线得出,BALFGM实验的ROC曲线下面积更大.由ROC曲线计算可得,I=0.805为BALFGM实验的最佳临界值,此时约登指数最大,敏感度、特异度分别为76.2%、73.1%,曲线下面积为0.734(95%CI:0.642~0.826).结论:与血清相比,BALFGM检测结果的敏感度和特异度更高,曲线下面积更大,由此判断BALFGM实验对儿童IPA的诊断价值更高.可将I=0.8作为BALFGM试验对儿童IPA的最佳诊断点.

Objective To evaluate the diagnostic value of galactomannan in bronchoalveolar lavage fluid(BALF)for children with invasive pulmonary aspergillosis(IPA).Methods A total of 172 childrenwith IPA suspectedwere selected from the Third Xiangya Hospital of Central South University.The diagnosed,clinically diagnosed and prospective diagnosed patients were divided into IPA groups.The patients who were diagnosed excluded were divided into non-IPA group.The GM test was performed using the enzyme-linked immunosorbent assay.The diagnostic value of BALF and serum GM assays for IPA was calculated by plotting the ROC curve.The diagnostic efficiencies of BALF and serum GM assays with positive thresholds of 0.5,0.8,and 1.0 were calculated.Determine the best cutoff value.Results Combined with data analysis,the best diagnostic point of IPA can be obtained from I=0.6 GM test,and I=0.8 is the best diagnostic point for IPA test of BALF GM.Compared with the sensitivity(61.9%)and specificity(79.2%)of serum GM detection results at I=0.6,the sensitivity(78%)and specificity(73.4%)of IPA in I=0.8 were improved,and the difference was statistically significant.Drawing the ROC curve shows that the area under the ROC curve of BALF GM experiment is larger.According to the calculation of ROC curve,I=0.805 is the best critical value of BALF GM experiment.At this time,the maximum index is 76.2%,the specificity is 73.1%,and the area under the curve is 0.734(95%CI:0.642~0.826).Conclusion Compared with serum,the sensitivity of BALF GM test is higher and the AUC is larger.Therefore,the BALF GM test has higher diagnostic value for children with IPA.The point 0.8 can be used as the best diagnostic point for children's IPA in the BALF GM test,which provides a basis for clinical effective prevention and treatment of IPA.