侵袭性肺曲霉菌感染实验诊断新进展

Progress of IPAI experimental diagnosis

从病原学(涂片镜检、培养)、组织病理学、分子生物学和13种曲霉菌生物标志物及联合检测等方面探讨不同侵袭性肺曲霉菌感染(IPAI)检测方法的诊断效能。组织病理学阳性率为87.5%;涂片镜检敏感性为87.7%、特异性为72.1%;培养阳性率<61%,其中痰液、支气管肺胞灌洗液(BALF)、血液样本培养阳性率分别为12%、40%~50%、<5%;聚合酶链反应(PCR)的检测敏感性和特异性分别为50%~100%和75%~89%;生物标志物敏感性为61%~100%、特异性为77%~95%;联合检测敏感性为73%~94%、特异性为0.81%~99.4%。不同检测方法的敏感性和特异性差异较大。生物标志物检测具有快速、敏感、特异的特点;联合检测诊断意义较大。

The diagnostic performance of invasive pulmonary Aspergillus infection(IPAI)determinations were evaluated in terms of etiology(smear microscopy,culture),immunohistochemistry,molecular biology,13 kinds biomarkers of Aspergillus and combined determination.The positive rate of immunohistochemistry was 87.5%.The sensitivity of smear microscopy was 87.7%,and the specificity was 72.1%.The positive rate of culture was<61%.Among these specimens,sputum accounted for 12%,bronchoalveolar lavage fluid(BALF)accounted for 40%-50%,and blood accounted for<5%.The sensitivity and the specificity of molecular biology were 50%-100%and 75%-89%,respectively.The sensitivity of biomarkers was 61%-100%,and the specificity was 77%-95%.The sensitivity of combined determination was 73%-94%,and the specificity was 0.81%-99.4%.The sensitivities and specificities of these technologies are different,the determations of biomarkers have the characteristics of rapidity,high sensitivity and high specificity,and the combined determination is of great significance.