支气管肺泡灌洗液半乳甘露聚糖检测在慢性阻塞性肺病合并侵袭性肺曲霉病诊断中的研究

The Research of Galactomannan Testing in Bronchoalveolar Lavage Fluid on the Diagnosis of Invasive Pulmonary Aspergillosis with Chronic Obstructive Pulmonary Disease

目的探讨支气管肺泡灌洗液(BALF)中半乳甘露聚糖(GM)检测在慢性阻塞性肺疾病(COPD)合并侵袭性肺曲霉病(IPA)的早期诊断价值。方法前瞻性收集105例收住呼吸科的COPD患者,分为确诊IPA、临床诊断IPA、拟诊IPA和非IPA患者,分别入组病例组和对照组,并检测血清和BALF中的GM。结果病例组血清及BALF中的GM值均显著高于对照组。以GM值≥0.5为界值时,BALF中的GM检测的阳性预测值、阴性预测值、敏感度及特异度分别为72.1%,96.8%,93.9%和83.3%;而血清GM检测分别为65.5%,81.6%,57.6%和86.1%。以GM值≥1.0为界值时,BALF中GM的阴性预测值及敏感性明显高于血清GM检测(80.9%,48.5%vs 69.2%,3%),二者阳性预测值、特异度均为100%;当GM值≥0.60时,BALF中的GM检测诊断效率最高。病例组抗真菌治疗后,IPA患者症状改善,BALF中的GM明显下降。结论在COPD患者合并IPA中,BALF中的GM检测比血清GM检测具备更高的早期诊断价值。BALF中的GM≥0.6可以考虑作为诊断该疾病的最佳界值,动态监测其水平对IPA预后评估有临床意义。

Objective To investigate the effectiveness of bronchoalveolar lavage fluid(BALF)galactomannan(GM)test in diagnosing invasive pulmonary aspergillosis(IPA)in patients with chronic obstructive pulmonary disease(COPD).Methods We recruited 105 COPD patients hospitalized in the Department of Respiratory Medicine of Fujian Medical University Union Hospital.Thirty-three patients were assigned into IPA group(3 with proven,12 with probable,and 18 with possible IPA),and 72 IPA-negative patients were assigned into control group.GM in serum and BALF was examined.Results The IPA group had significantly higher concentrations of GM in serum and BALF than the control group.At the cutoff of GM≥0.50,the positive and negative predictive values,the sensitivity,and specificity of BALF GM were 72.1%,96.8%,93.9%and 83.3%,respectively,whereas those of serum GM were 65.5%,81.6%,57.6%,and 86.1%,respectively.At the cutoff of GM≥1.00,the negative predictive value and sensitivity of BALF GM were significantly higher than those of serum GM(80.9%vs 69.2%;48.5%vs 3%);the specificity and positive predictive value of both serum and BALF GM were 100%.The optimal cutoff for the diagnostic performance of BALF GM was≥0.60,at which the highest diagnostic effectiveness was presented.Patients in the IPA group showed symptom improvement after anti-fungal treatment,accompanied with a significant decrease of GM concentration in BALF.Conclusions BALF GM performs better than serum GM in diagnosing IPA in COPD patients.BALF GM≥0.6 is the optimal cutoff for IPA diagnosis.Monitoring BALF GM may help predicting IPA prognosis.