GM试验诊断非粒缺患者侵袭性肺曲霉菌病的临床价值研究

The clinical value of serum galactomannan antigen test in diagnosis of invasive pulmonary aspergillosis in non-neutropenic patients

目的探讨血清半乳甘露聚糖抗原(GM试验)用于诊断非粒细胞缺乏患者侵袭性肺曲霉菌病(IPA)的最佳诊断界值(cut-off),并评价其临床诊断价值.方法回顾性分析2016年1月至2017年7月347例呼吸科存在侵袭性真菌感染因素的住院患者临床症状、真菌学指标以及中性粒细胞结果,利用血清GM试验的受试者工作曲线(ROC曲线),得出其cut-off值,并评价GM试验用于诊断呼吸科非粒缺患者IPA的灵敏度、特异性、阳性预测值和阴性预测值.结果在非粒细胞缺乏的患者中,IPA组、其他真菌感染组和排除诊断组的血清GM指数[M(P25,P75)]分别为0.36(0.18,0.48)、0.27(0.18,0.39)和0.22(0.17,0.29);GM的cut-off值在0.35时灵敏度和特异性之和最大,其AUC=0.660(95%CI:0.556~0.764),P<0.01;灵敏度为53.85%,特异性为82.39%,阳性预测值为29.58%,阴性预测值为92.86%,约登指数为36.24%.结论在非粒缺呼吸科患者中,血清GM试验诊断侵袭性肺曲霉菌病准确度中等偏下,血清GM指数在0.35时诊断效能最高.

Objective To explore the cut-off of serum galactomannan antigen detection for invasive pulmonary aspergillosis in non-neutropenic patients and evaluate its clinical diagnostic value. Methods The clinical symptoms,mycology and neutrophils results of 347 hospitalized patients in the department of respiratory of our hospital with high risk invasive fungal infections from January 2016 to July 2017 were analyzed in retrospect. ROC curve of GM test was used to seek the optimal diagnostic boundary value. The sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of GM test in the diagnosis of IPA were calculated. Results In non-neutropenic patients with respiratory,the serum GM[M(P25, P75)]of IPA,other fungal infection group and exclude diagnosis group were 0.36(0.18,0.48),0.27(0.18,0.39)and 0.22(0.17,0.29), respectively. ROC curve analysis showed that the area under curve was 0.660(95%CI:0.556~0.764),P<0.01,the diagnostic critical value was 0.35.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and Youden index of GM test were 53.85%, 82.39%,29.58%,92.86% and 36.24%,respectively. Conclusion The serum galactomannan(GM) antigen tests has low accuracy in the diagnosis of invasive pulmonary aspergillosis in non-neutropenic patients with respiratory. In non-neutropenic patients,the optimal diagnostic boundary value of serum GM for IPA diagnosis is 0.35.