血清半乳甘露聚糖检测在慢性阻塞性肺疾病并发侵袭性肺曲霉病中的诊断价值

Serum galactomannan test for diagnosis of invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

目的目前关于血清半乳甘露聚糖(GM)检测在侵袭性曲霉感染中的诊断价值,主要集中在血液病患者、粒细胞缺乏患者中,而对慢性阻塞性肺疾病(COPD)并发侵袭性肺曲霉病(IPA)的相关研究较少。文中旨在研究在COPD并发IPA患者中血清GM实验的诊断价值。方法选取2015年3月至2016年9月在南京军区南京总医院呼吸与危重症医学科住院资料完整的COPD患者60例,其中IPA组(确诊和临床诊断IPA患者)19例,非IPA组(非IPA患者)41例。采用ELISA法检测血清GM,评价其对COPD合并IPA患者的诊断价值;同时比较IPA组7名治疗有效患者治疗前后的GM值变化。结果当血清GM取0.5为阳性界值时,其敏感性、特异性、阳性预测值、阴性预测值分别为57.9%、95.1%、84.6%、83.0%,特异性较高,但敏感性不高。7例COPD合并IPA患者治疗后GM值较治疗前有显著下降[(0.30±0.21)vs(1.48±1.37),P=0.004]。结论血清GM检测在COPD合并IPA患者中的诊断价值有限,但是血清GM动态监测有利于掌握患者病情变化。

Objective The purpose of this study was to investigate the value of serum galactomannan （GM） in the diagnosis of invasive pulmonary aspergillosis （IPA） in patients with chronic obstructive pulmonary disease （COPD）. Methods We enrolled 60 COPD patients in the study, including 19 IPA and 41 non-IPA cases. We examined serum GM of the patients by ELISA, evaluate the value of serum GM test for the diagnosis of IPA in patients with COPD, and compared the GM values before and after treatment. Results With 0.5 as the positive cutoff value, the sensitivity, specificity, positive predictive value, and negative predictive value of serum GM were 57.9%, 95.3%, 84.6%, and 83.0%, respectively, with a high specificity and a low sensitivity. The 7 IPA cases showed a significantly decreased GM value after treatment as compared with the baseline （0.30±0.21 vs 1.48±1.37, P= 0.004）. Conclusion The serum GM test has a limited value in the diagnosis of IPA in patients with COPD, but dynamic monitoring of the changes of the serum GM value may help evaluate the patient＇s condition.