支气管肺泡灌洗液半乳甘露聚糖抗原检测在肺曲霉病诊断中的价值

Application of detecting bronchoalveolar lavage fluid Aspergillus galactomannan antigen in the diagnosis of pulmonary aspergillosis

目的探讨支气管肺泡灌洗液（BALF）中半乳甘露聚糖抗原（GM）检测在肺曲霉病诊断中的价值。方法将2008年8月至2012年4月山东省胸科医院呼吸科住院疑似肺曲霉感染121例患者，依据2008年欧洲癌症研究治疗组织／国立研究院（EORTC／MSG）真菌病研究小组制定的诊断标准及分级分为肺曲霉病组（57例）和非肺曲霉病组（64例），采用ELISA方法检测患者血清及BALF中GM抗原的吸光度（A）值及I值，并进行比较分析。结果肺曲霉病组经病理确诊20例、临床确诊37例，其血清及BALF中GM的I值平均秩次为88．21、86．49，较非肺曲霉病组（36．77、38．30）均明显升高（均P〈0．01）。血清GM检测的I值=0．5、0．8、1．0时，灵敏度为0．842、0．649、0．228，特异度为0．906、0．938、0．929，阳性预测值为0．889、0．902、0．984，阴性预测值为0．866、0．750、0．589，最佳临界值0．550。BALF中GM检测的I值=0．5、0．8、1．0时，灵敏度为0．930、0．657、0．561，特异度为0．766、0．922、0．969，阳性预测值为0．779、0．884、0．941，阴性预测值为0．925、0．756、0．713；最佳临界值为0．720。结论BALF中GM的检测可用于临床肺曲霉病的辅助诊断。

Objective To prospectively evaluate the utility of detecting bronchoalveolar lavage fluid （BALF） Aspergillus galactomannan antigen （GM） in the diagnosis of pulmonary aspergillosis. Methods From August 2008 to April 2012, 121 patients suspected of pulmonary aspergillosis were recruited and classified into pulmonary aspergillosis group （ n = 57 ） and non-pulmonary disease group （ n = 64） according to the 2008 diagnostic criteria and classification of European Organization for Research and Treatment of Cancer/ National Institute of Mycoses Study Group （EORTC/MSG）. The absorbency （A） and I value of GM in the patients＇ serum and BALF were detected by enzyme-linked immunosorbent assay （ELISA）. And their values were compared and analyzed. Results Twenty cases were confirmed by pathological examinations and 37 cases by clinical diagnosis in the pulmonary aspergillosis group. The mean rank of GM＇s I value in the serum and BALF samples was 88. 21 and 86.49. And they significantly increased compared with the non-pulmonary aspergillosis group （36. 77, 38. 30） （P 〈0. 01 ）. At a different serum GM threshold I = 0. 5, 0. 8, 1.0, the sensitivities were 0. 842, 0. 649 and 0. 228 ; the specificities 0. 906, 0. 938, 0. 929 ; the positive predictive values 0. 889, 0. 902, 0. 984 and the negative predictive values 0. 866, 0. 750, 0. 589 respectively. And at a different BALF GM threshold I = 0. 5, 0. 8, 1.0, the sensitivities were 0. 930, 0. 657, 0. 561 ; the specificities 0. 766, 0. 922, 0. 969 ; the positive predictive values O. 779, 0. 884, 0. 941 and the negative predictive values 0. 925, 0. 756, 0. 713 respectively. Conclusion The detection of GM in BALF may be employed for the clinical diagnosis of pulmonary aspergillosis.