支气管肺泡灌洗液GM检测对侵袭性肺曲霉病的诊断价值

The value of bronchoalveolar lavage fluid galactomannan detection in diagnosing of invasive pulmonary aspergillosis

目的:探讨支气管肺泡灌洗液(BALF)半乳甘露聚糖(GM)检测在侵袭性肺曲霉病(IPA)诊断中的价值。方法:收集临床疑诊IPA的呼吸科患者,用ELISA方法行BALF和血清GM检测,用统计学方法了解BALF GM检测的诊断效率。结果:共入选82例临床高度怀疑IPA的患者,其中2例确诊IPA,10例临床诊断IPA,7例拟诊IPA,共计19例作为病例组,其余63例非IPA患者作为对照组。当以GM值为0.5作为界值时,BALF GM检测的敏感度、特异度、阳性预测值和阴性预测值分别为84.2%、82.5%、59.3%和94.5%,而血清GM检测在同样界值时的敏感度、特异度、阳性预测值和阴性预测值分别为52.6%、90.5%、62.5%和86.4%;以GM值为1.0作为界值时,BALF和血清GM的特异度、阳性预测值均可达100%,但BALF GM检测的敏感度和阴性预测值(68.4%和91.3%)明显高于血清GM检测(26.3%和81.8%)。结论:BALF GM检测在诊断IPA中具有重要意义,值得推广。

Objective To evaluate the role of galactomannan（GM） detection in bronehoalveolar lavage fluid （BALF） in the diagnosis of invasive pulmonary aspergillosis （IPA）. Method The patients in department of respiration suspected of having IPA were enrolled. GM was detected in BALF and serum by ELISA. Results Among 82 enrolled patients, 19 cases were diagnosed with IPA, including 2 proven, 10 probable and 7 possible. The remained 63 patients were as control group. Based on a GM index cutoff value of 90. 5 ,the sensitivity,speci- ficity ,positive predictive value and negative predictive value for BALF were 84. 2% ,82. 5% ,59. 3% and 94. 5% ,respectively,these varia- bles in serum were 52. 6% ,90. 5% ,62. 5% and 86. 4% respectively. Using a GM index cutoff value ≥ 1.0,tbe specificity and positive predictive value of both BALF GM and sermn GM reached 100% ,but the sensitivity and negative predictive value of BALF GM were higher than serum GM（68. 4% and 91.3% ,26.3% and 81.8% ,respectively）. Conclusion GM detection in BALF seems to be a useful tool in the diagnosis of IPA in patients with lung diseases,and could be widely used in future.