BALF-GM检测联合血清烟曲霉IgG在支气管扩张合并慢性肺曲霉菌病诊治中的意义

目的 通过分析支气管扩张合并慢性肺曲霉菌(CPA)患者的肺泡灌洗液(BALF)半乳甘露聚糖(GM)及血清烟曲霉特异性抗体IgG的检测值,探讨BALF-GM及血清烟曲霉IgG在支气管扩张并CPA患者诊断及评估其疗效的价值.方法 对2017年1月至2020年1月本院收治的53例支气管扩张并同时行BALF-GM及血清烟曲霉IgG检测患者的临床资料进行回顾性分析.确诊为支气管扩张合并CPA的为观察组,支气管扩张未合并CPA的为对照组,同时检测患者血清烟曲霉IgG以及BALF-GM值,计算不同界值的诊断效率并运用ROC曲线分析各检测方法对CPA的诊断效果.结果 观察组的BALF中的GM值及血清烟曲霉IgG均明显高于对照组.观察组BALF-GM以≥0.5较≥1为界值其敏感性(88.6%vs.72.3%)和阴性预测值(77.8%vs.27.8%)均明显升高.根据ROC曲线结果BALF的GM界值为0.55时其诊断效率最高.血清烟曲霉抗体IgG检测(>120AU/ml)的敏感性和特异性分别为83.3%、94.3%.观察组中4例治疗常规的患者中复查血清烟曲霉IgG均有不同程度下降.根据ROC曲线显示两者联合时曲线下面积最大为0.956.结论 BALF-GM、血清烟曲霉IgG检测对支气管扩张合并CPA的诊断具有高度特异性,血清烟曲霉IgG的敏感性优于BALF-GM检测,两者联合检测诊断效率更高,诊断支气管扩张合并CPA的BALF-GM界值可选0.55,监测血清烟曲霉IgG水平可能对其评估临床疗效有意义.

Objective To analyze the bronchiectasis complicated with chronic pulmonary aspergillosis(CPA)patients with bronchoalveolar lavage fluid(BALF)galactomannan(GM)and serum Aspergillus-specific IgG detection value,to explorethe value of BALF-GM and Aspergillus IgG indiagnosis and efficacy onbronchiectasis complicated with CPA patients.Methods The clinical data of 53 patients with bronchiectasis who underwent BALF-GM and serum Aspergillus-specific IgG tested from January 2017 to January 2020 were retrospectively analyzed.Cases diagnosed with bronchiectasis complicated with CPA were the case group,and those with bronchiectasis without CPA were the control group.At the same time,the patient's serum Aspergillus-specific IgG and BALF-GM values were detected,the diagnostic efficiency of different cut off values was calculated,and the ROC curve was used to analyze the diagnosis of CPA by various detection methods.Results The BALF-GM and serum Aspergillus IgG in the case group were significantly higher than those in the control group.In the case group,considering a cut point of 1.0,the sensitivity was 27.8% and negative predictive value was 72.3%.Considering a cut point of 0.5,the sensitivity was 77.8% and negative predictive value was 88.6%.According to the ROC curve result,the BALF GM cut-off value was 0.55,and its diagnostic efficiency was the highest.The sensitivity and specificity of serum Aspergillus-specific IgG detection(>120AU/ml)were 83.3% and 94.3%,respectively.4 patients in the case group,the re-examination of serum Aspergillus-specific IgG in the routine treatment patients all decreased to varying degrees.According to the ROC curve,when the two were combined,the maximum value under the curve was 0.956.Conclusion The detection of BALF-GM and Aspergillas IgG is highly specific for the diagnosis of bronchiectasis combined with CPA.The sensitivity of serum Aspergillus-specific IgG is better than that of BALF-GM.The combination of the two tests is more efficient.BALF-GM≥0.55 can be considered as a diagnosis The optimal cut-off value of the disease,monitoring Aspergillus IgG levels may be meaningful for its clinical efficacy.