血清和支气管肺泡灌洗液半乳甘露聚糖检测诊断COPD合并侵袭性肺曲霉病价值比较

Comparison of galactomannan in serum and bronchoalveolar lavage fluid in the diagnosis of COPD complicated with invasive pulmonary aspergillosis

目的比较不同诊断阈值的肺泡灌洗液(broncho alveolar lavage fluid,BALF)半乳甘露聚糖(galactomannan,GM)试验和血清GM试验诊断慢性阻塞性肺疾病(COPD)合并侵袭性肺曲霉病(invasive pulmonary aspergillosis,IPA)的价值。方法选取2019年7月~2021年6月淮北市人民医院122例COPD患者,根据EORTC/MSG诊断标准,将确诊、临床诊断、拟诊IPA患者39例纳入IPA组,非IPA组83例。取外周静脉血和BALF进行GM试验,血清GM值≥0.5为阳性,BALF阈值选取0.5、0.8、1.0,分别计算其诊断IPA的灵敏度、特异性、阳性预测值、阴性预测值、约登指数。结果IPA组与非IPA组血清、BALF的GM值差异均有统计学意义(P<0.05),IPA组BALF的GM值高于血清GM值,差异有统计学意义(P<0.05)。血清GM试验敏感度66.67%,约登指数0.57,BALF阈值取0.5、0.8、1.0的敏感度分别为94.87%、84.62%、64.10%,BALF0.5、0.8、1.0阈值的约登指数均高于血清GM,其中0.8阈值的约登指数最高,为0.82。结论对于COPD患者合并侵袭性肺曲霉病的诊断,肺泡灌洗液GM试验较血清GM试验具有更高的敏感度,BALF-GM试验诊断阈值选择0.8比1.0具有更高的诊断效能。

Objective To compare the galactomannan(GM)test of alveolar lavage fluid(BALF)and serum GM test with different diagnostic thresholds in the diagnosis of COPD complicated with invasive pulmonary aspergillosis.Methods 122 patients with COPD were included in the study.According to the EORTC/MSG diagnostic criteria,39 patients with confirmed,clinically diagnosed and proposed IPA were included in the IPA group and 83 patients in the non IPA group.Peripheral venous blood and BALF were taken for GM test.The serum GM value≥0.5 was positive,and the BALF threshold was 0.5,0.8 and 1.0.The sensitivity,specificity,positive predictive value,negative predictive value and Youden index were calculated.Results The GM value of serum and BALF in IPA group was significantly higher than that in non IPA group(P<0.05).The sensitivity of serum GM test was 66.67%,Youden index was 0.57,and the sensitivity of BALF threshold of 0.5,0.8 and 1.0 were 94.87%,84.62%,64.10%.The Youden index of 0.8 and 1.0threshold was higher than that of serum GM,and the Youden index of 0.8 threshold was the highest,which was 0.82.Conclusion For the diagnosis of COPD patients complicated with invasive pulmonary aspergillosis,alveolar lavage fluid GM test has higher sensitivity than serum GM test,and BALF-GM test has higher diagnostic efficiency when the diagnostic threshold is 0.8 than 1.0.