曲霉菌IgG联合GM试验对慢阻肺患者肺曲霉病的诊断价值

A Value Analysis of Aspergillus IgG Combined with GM Test on theDiagnosis of Pulmonary Aspergillosis in Patients with COPD

目的曲霉菌免疫球蛋白G(immunoglobulin G,IgG)联合半乳甘露聚糖(galactomannan,GM)试验诊断慢阻肺(chronic obstructive pulmonary disease,COPD)患者肺曲霉病的价值分析。方法选取我院自2017年5月至2020年11月接收的慢阻肺疑似肺曲霉病患者144例,收集所有患者的临床资料,采集患者的支气管肺泡灌洗液和静脉血,分别行肺泡灌洗液、血清GM试验和血清曲霉菌IgG检测,分析不同临界值(120 kAU/L、140 kAU/L)曲霉菌IgG诊断的特异性、灵敏度、准确度、阳性预测值、阴性预测值,比较曲霉菌IgG联合GM试验、单独曲霉菌IgG检测、单独GM试验对肺曲霉病的诊断效能。比较曲霉菌感染阳性、阴性患者在治疗前后的GM试验吸光度、血清IgG检测值情况。结果以140 kAU/L为临界值曲霉菌IgG诊断肺曲霉病的特异性、阳性预测值高于以120 kAU/L为临界值的指标,差异具有统计学意义(P<0.05);曲霉菌IgG联合GM试验诊断的准确度、灵敏度、阴性预测值优于单独曲霉菌IgG检测、单独GM试验,差异具有统计学意义(P<0.05)。阳性患者的GM试验结果肺泡灌洗液、血清吸光度高于阴性患者,差异具有统计学意义(P<0.05);阳性患者治疗后转阴患者的GM试验结果肺泡灌洗液、血清吸光度低于治疗前,差异具有统计学意义(P<0.05)。阳性患者的血清IgG检测值高于阴性患者,差异具有统计学意义(P<0.05);阳性患者治疗后转阴患者的血清IgG检测值低于治疗前,差异具有统计学意义(P<0.05)。结论采用曲霉菌IgG联合GM试验诊断可增强临床中对慢阻肺患者肺曲霉病的诊断效能,曲霉菌IgG诊断时可选取140 kAU/L作为临界值。通过GM试验结果和血清IgG检测值的变化可反映慢阻肺患者肺曲霉病感染的疗效情况,值得临床推行。

Objective To analyze the value of Aspergillus immunoglobulin G(IgG)combined with galactomannan(GM)test on the diagnosis of pulmonary aspergillosis in patients with chronic obstructive pulmonary disease(COPD).Methods 144 patients with COPD and suspected pulmonary aspergillosis in our hospital from May,2017 to November,2020 were selected for the current study.The clinical data of all patients were collected.Bronchoalveolar lavage fluid and venous blood of all patients were collected.GM test and Aspergillus IgG detection were performed respectively.The specificity,sensitivity,accuracy,positive predictive value and negative predictive value were calculated and selected at different critical values(120 kAU/L and 140 kAU/L).The diagnostic efficacies among Aspergillus IgG combined with GM test,single Aspergillus IgG detection and single GM test for pulmonary aspergillosis were compared.The absorbance of GM test and the detection value of serum IgG in patients with positive and negative Aspergillus infection before and after treatment were compared.Results The specificity and positive predictive value of 140kAU/L for the diagnosis of pulmonary aspergillosis were higher than those of 120kAU/L(P<0.05).The accuracy,negative predictive value and sensitivity of Aspergillus IgG combined with GM test were higher than those of single Aspergillus IgG detection and single GM test(P<0.05).The results of GM test in positive patients were higher than those in negative patients(P<0.05),GM test results of positive patients after treatment turned negative were lower than those of before treatment(P<0.05).The serum IgG detection value of positive patients was higher than that of negative patients(P<0.05).Serum IgG value of positive patients after treatment was lower than that of before treatment(P<0.05).Conclusion Aspergillus IgG combined with GM test can enhance the diagnostic efficiency of pulmonary aspergillosis in COPD patients.140kAU/L can be selected as the critical value for the diagnosis of Aspergillus IgG.The results of GM test and the changes of serum IgG can reflect the curative effect of pulmonary Aspergillosis in COPD patients,which is worthy of clinical promotion.