支气管肺泡灌洗液GM试验对慢性肺曲霉病的早期诊断及疗效评估价值

Early diagnostic value and curative effect evaluation of galactomannan test in bronchoalveolar lavage fluid for chronic pulmonary aspergillois

目的探讨支气管肺泡灌洗液(BALF)检测半乳甘露聚糖(GM试验)在慢性肺曲霉病(CPA)的早期诊断及治疗评估中的价值。方法选取2017年1月至2018年12月在我院肺结核科就诊的且资料完整的肺部感染患者155例作为研究对象,其中观察组为CPA患者,共75例,对照组为非CPA患者,共80例。分别采集两组患者的BALF及血清进行GM检查,对两组结果进行分析、统计,同时对观察组病人(均进行抗真菌及介入治疗)的BALF-GM进行动态检测,分别记录治疗前,治疗后第一月,第三月的BALF-GM值。结果以我院的检验标准BALF-GM≥0.9为阳性诊断标准,观察组中阳性者有86.67%最后符合病理确诊诊断。当BALF-GM阳性阈值为0.9时,观察组诊断CPA的特异度、灵敏度、阴性预测值及阳性预测值分别为93.75%、86.67%、88.23%及86.67%。观察组81.3%的病人BALF-GM值在第三个月时可降至0.9(阈值)以下。结论支气管肺泡灌洗液GM值对慢性肺曲霉病的早期诊断具有较高的敏感性和特异性,同时可作为预测治疗效果的标志物之一,具有重要的临床检验价值。

Objective To evaluate the early diagnostic value and curative effect of galactomannan test in bronchoalveolar lavage fluid for chronic pulmonary aspergillois. Methods A total of 155 patients with suspected pulmonary inflammatory diseases were enrolled in Pulmonary Tuberculosis Department of Guangzhou Chest Hospital from January 2017 to December 2018. These cases were divided into the CPA group and the non-CPA group. GM in BALF and serum were detected in both groups, and the results were analyzed. BALF GM of the CPA group(all received antifungal treatment and bronchoscopic interventional treatment) were dynamic tested in pre-antifungal treatment, and 1 and 3 months after treatment. Results Based on a GM index cut-off value ≥0.9 as positive, the compliance with pathological diagnosis in the CPA group was 86.67%. When the cut-off value of GM was 0.9, the specificity, sensitivity, negative predictive value and positive predictive value for BALF were 93.75%, 86.67%, 88.23% and 86.67%. The GM index in BALF of 81.3% patients in the CPA group were gradually decreased below 0.9 at the third month. Conclusion The value of GM in BALF has high sensitivity and specificity for early diagnosis of chronic pulmonary aspergillois, which can be used as one of the markers of predicting the therapeutic effect simultaneously, and has important clinical test value.