支气管肺泡灌洗液的半乳甘露聚糖检测在侵袭性肺曲霉病早期诊断中的应用分析

Application and analysis of galactomannan of bronchoalveolar lavage fluid in the early diagnosis of invasive pulmonary aspergillosis

目的评价支气管肺泡灌洗液中半乳甘露聚糖检测对于侵袭性肺曲霉病早期诊断的临床意义。方法通过对90例因肺部感染入院就诊的患者行支气管肺泡灌洗液(BALF)的半乳甘露聚糖(GM)检测,对比分析BALF及血清GM检测对于侵袭性肺曲霉病的诊断效率。结果 90例患者中确诊IPA 3例,临床诊断IPA 12例,拟诊IPA9例;以I=0.5作为临界值诊断,BALF及血清GM检测的敏感度、特异度、阳性预测值和阴性预测值分别为87.50%、81.82%、63.64%、94.74%和54.17%、90.91%、68.42%、84.51%;以I=1.0作为临界值,BALF及血清GM检测的敏感度、特异度、阳性预测值和阴性预测值分别为66.67%、100.00%、100.00%、89.19%和25.00%、100.00%、100.00%、78.57%;BALF和血清GM检测的特异度和阳性预测值均达到100%,但BALF GM检测的敏感度较血清GM检测显著升高(P<0.05),而BALF GM检测的阴性预测值较血清GM检测也升高,但差异无统计学意义(P>0.05)。结论与血清GM检测相比,BALF GM检测诊断的敏感度、特异度以及阳性/阴性预测值均有所提高,对于IPA的诊断更早、更准确,值得在临床中广泛应用。

Objective To evaluate the clinical influence of galactomannan （GM） detection in bronchoalveolar lavage flu- id （BALF） in the diagnosis of invasive pulmonary aspergillosis （IPA）. Methods 90 cases with lung infection admitted into the hospital were selected to detect GM in BALF,and then the detection efficiency of both BALF and serum GM for the diagnosis of IPA were analyzed comparatively. Results Among 90 patients enrolled,3 cases were diagnosed as I- PA,12 cases were diagnosed clinically as IPA,9 cases were diagnosed suspected as IPA;taking I=0.5 as the critical val- ue of diagnosis,the sensitivity,specificity,positive predictive value and negative predictive value for BALF were 87.50%, 81.82%,63.64%,94.74% and those for serum GM were 54.17%,90.91%,68.42%,84.51% respectively;taking I=1.0 as the critical value of diagnosis,the sensitivity,specificity,positive predictive value and negative predictive value for BALF were 66.67%,100.00%,100.00%,89.19% and those for serum GM were 25.00%,100.00%,100.00%,78.57% respectively; the specificity and positive predictive value of both BALF and serum GM reached 100%,but the sensitivity of BALF GM were higher than serum GM （P〈0.05） and the negative predictive value of BALF GM have a little improvement,but no significant difference compared with serum GM detection （P〉0.05）. Conclusion Compared with serum GM detection, the sensitivity,specificity,positive/negative predictive values of BALF GM were improved for the early diagnosis of IPA, and the diagnosis for IPA is earlier and more accurate,and it is widely used in clinic.