支气管肺泡灌洗液GM试验联合血清G、GM试验在慢性肺曲霉菌病中的诊断价值

Value of GM test for bronchoalveolar lavage fluid combined with serum G and GM tests in diagnosing chronic pulmonary aspergillosis

目的探讨支气管肺泡灌洗液(BALF)半乳甘露聚糖(GM)试验与血清(1,3)-β-D-葡聚糖抗原(G)试验、GM试验联合检测在慢性肺曲霉菌病(CPA)中的诊断价值。方法选取2020年7月至2022年6月牡丹江医学院附属红旗医院呼吸与危重症医学科住院的疑似CPA感染患者69例,行BALF GM试验及血清G、GM试验,确诊CPA感染患者30例,非CPA感染患者39例,对试验结果进行处理分析。结果BALF GM试验的敏感度、特异度、阳性预测值(PPV)、阴性预测值(NPV)分别为73.33%、64.10%、61.11%和75.76%;血清G、GM试验联合分别为63.33%、82.05%、73.08%和74.42%;BALF GM试验联合血清G、GM试验分别为93.33%、66.67%、68.29%和92.86%;CPA组BALF GM及血清G、GM水平分别为[1.31(0.61,2.07)]μg/L、[95.50(50.00,100.00)]pg/ml、[0.86(0.35,0.94)]μg/L,均显著高于非CPA组的[0.45(0.13,0.96)]μg/L、[60.00(40.00,68.00)]pg/ml、[0.34(0.09,0.86)]μg/L,差异有统计学意义(P<0.05);绘制ROC曲线得出,BALF GM试验与血清G、GM联合检测工作特性曲线下的面积分别为0.756、0.778,三者联合检测工作特性曲线下的最大面积为0.834。结论BALF GM试验联合血清G试验、GM试验检测可有效提高CPA临床诊断率。

Objective To investigate the value of galactomannan(GM)test for bronchoalveolar lavage fluid(BALF)combined with serum(1,3)-β-D-glucan antigen(G)and GM tests in diagnosing chronic pulmonary aspergillosis(CPA).Methods A total of 69 patients with suspected CPA infection hospitalized in the Department of Respiratory and Critical Care Medicine of Hongqi Hospital Affiliated to Mudanjiang Medical University from July 2020 to June 2022 were selected for BALF GM test and serum G and GM tests.30 patients were included in the confirmed CPA infection group and 39 patients were included in the non-CPA infection group.The test results were processed and analyzed.Results The sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)were 73.33%,64.10%,61.11%and 75.76%respectively for BALF GM test,63.33%,82.05%,73.08%and 74.42%respectively for the combination of serum G and GM tests,and 93.33%,66.67%,68.29%and 92.86%respectively for the combination of BALF GM test with serum G and GM tests.The levels of BALF GM,serum G and GM in the confirmed CPA infection group were(1.31[0.61,2.07])μg/L,(95.50[50.00,100.00])pg/ml and(0.86[0.35,0.94])μg/L,respectively,which were significantly higher than those in the non-CPA infection group(0.45[0.13,0.96])μg/L,(60.00[40.00,68.00])pg/ml,(0.34[0.09,0.86])μg/L,with statistically significant differences(P<0.05).According to the receiver operating characteristic(ROC)curve,the area under the curve(AUC)of the BALF GM test and the combination of serum G and GM tests was 0.756 and 0.778,respectively,and the maximum AUC of the combination of the three tests was 0.834.Conclusion The combination of BALF GM test with serum G and GM tests can effectively improve the clinical diagnosis rate of CPA.