高分辨胸部CT联合支气管肺泡灌洗液GM试验对侵袭性肺曲霉病早期诊断价值

Diagnostic value of high resolution chest CT combined with GM test of bronchoalveolar lavage fluid for early diagnosis of invasive pulmonary aspergillosis

目的:探讨高分辨胸部CT联合支气管肺泡灌洗液GM试验对侵袭性肺曲霉病(IPA)早期诊断价值。方法:对在本院2016年1月-2019年11月114例高度疑似IPA住院患者高分辨胸部CT和支气管肺泡灌洗液GM试验资料进行回顾性分析。将确诊、临床诊断病例编入感染组,非曲霉菌感染病例编入非感染组。分析IPA早期高分辨胸部CT征象;同时对患者支气管肺泡灌洗液进行GM试验。分3组比较敏感度、特异度、阳性预测率及阴性预测率诊断效能:HRCT组、GM试验组、HRCT与GM试验联合组。结果:IPA感染组51例,非感染组63例。感染组12例出现为楔形及斑片浸润影,8例出现晕征,5例出现两肺多发小结节,2例出现实变病灶内出现空洞。HRCT组敏感度、特异度、阳性预测率及阴性预测率分别为58.8%、85.7%、76.9%、72.0%。GM试验组敏感度、特异度、阳性预测率及阴性预测率分别为74.6%、88.9%、84.4%、81.2%。联合试验组敏感度、特异度、阳性预测率及阴性预测率分别为92.2%、79.4%、78.3%、92.6%。结论:相对于单独胸部CT和支气管肺泡灌洗液GM试验,高分辨胸部CT联合支气管肺泡灌洗液GM试验联合检测能增加IPA的敏感性及阴性预测率,对侵袭性肺曲霉病早期诊断有帮助。

Objective:To investigate the early diagnosis value of HRCT combined with GM test of bronchoalveolar lavage fluid in the pulmonary aspergillosis(IPA).Methods:The data of chest HRCT and GM test of bronchoalveolar lavage fluid of 114 inpatients with highly suspected IPA admitted in Traditional Chinese Medicine Hospital of Zhongshan from January 2016 to November 2019 were retrospectively analyzed.The confirmed cases and clinical cases were classified into the infection group,and the non-aspergillus infection cases were included in the non-infection group.The early chest HRCT signs of IPA were analyzed and GM test on bronchoalveolar lavage fluid of the patients were carried out.The sensitivity,specificity,positive predictive value and negative predictive value were compared in three groups:HRCT group,GM test group and HRCT combined with GM test group.Results:There were 51 cases in IPA infection group and 63 cases in non-infection group.In the infection group,12 cases showed wedge-shaped and patchy infiltration shadow,8 cases showed halo sign,5 cases showed multiple small nodules in both lungs,2 cases showed consolidation and cavity in the lesion.The sensitivity,specificity,positive predictive value and negative predictive value of IPA diagnosed by HRCT were 58.8%,85.7%,76.9%and 72.0%.GM test,respectively,74.6%、88.9%、84.4%、81.2%;HRCT combined with GM test,respectively,92.2%、79.4%、78.3%、92.6%.Conclusion:Relative to HRCT and GM tests used alone to diagnose IPA,HRCT combined with GM test can improve the sensitivity and negative predictive value of IPA diagnosis.It is helpful for the early diagnosis of IPA.