肺泡灌洗液半乳甘露聚糖检测对非粒细胞缺乏患者侵袭性肺曲霉病的诊断价值评估及影响因素分析

Evaluation of the diagnostic value of alveolar lavage fluid galactomannan detection in patients with nonagranulocytosis with invasive pulmonary aspergillosis and analysis of influencing factors

目的探讨肺泡灌洗液(BALF)半乳甘露聚糖(GM)检测对非粒细胞缺乏患者侵袭性肺曲霉病(IPA)的诊断价值及影响因素。方法回顾性分析2018年7月至2020年7月本院收治的200例怀疑为IPA的非粒细胞缺乏患者的临床资料,根据IPA诊断结果分为确诊IPA患者(n=9)、临床诊断联合拟诊IPA患者(n=24)、非IPA患者(n=144),均收集BALF,比较3类患者中BALF的GM值,分析BALF中GM检测对非粒细胞缺乏患者IPA的诊断效能及假阳性、假阴性出现原因。结果确诊IPA患者、临床诊断联合拟诊IPA患者BALF中GM检测值均高于非IPA患者,且确诊IPA患者高于临床诊断联合拟诊IPA患者,差异有统计学意义(P<0.05)。BALF中GM的最佳临界值为0.88,约登指数为0.762,灵敏度为90.91%,特异度为85.42%,阳性预测值为55.56%,阴性预测值为97.56%,AUC为0.880,不同GM检测值比较差异有统计学意义(P<0.05)。以0.88作为BALF中GM检测的最佳临界值时,GM检测出现假阳性的原因主要为隐球菌感染和使用半合成类青霉素,出现假阴性的原因为使用抗真菌药物。结论BALF中GM值为0.88时对非粒细胞缺乏患者IPA有最佳的诊断效能,GM检测的假阳性结果与隐球菌感染和半合成类青霉素使用密切相关,假阴性结果与抗真菌药物使用密切相关。

Objective To investigate the diagnostic value and influencing factors of alveolar lavage fluid(BALF)galactomannan(GM)detection in patients with non-agranulocytosis with invasive pulmonary aspergillosis(IPA).Methods The clinical data of 200 patients with suspected agranulocytosis with IPA admitted to our hospital from July 2018 to July 2020 were retrospectively analyzed,and they were divided into patients with confirmed IPA(n=9),patients with clinical diagnosis combined with probable IPA(n=24),and non-IPA patients(n=144)according to the diagnosis of IPA,all collect BALF,the GM values in BALF were compared to analyze the diagnostic efficacy of GM detection in BALF on IPA in patients with agranulocytosis and the causes of false positive and false negative results.Results The GM detection values in BAALF were higher in patients with confirmed IPA and clinical diagnosis combined with probable IPA than in patients with clinical diagnosis and probable IPA,and the patients with confirmed IPA were higher than those with clinical diagnosis combined with probable IPA,and the difference was statistically significant(P<0.05).The optimal cut-off value of GM in BALF is 0.88,when the Jordon index is the highest,which is 0.762,sensitivity is 90.91%,specificity is 85.42%,positive predictive value is 55.56%,negative predictive value is 97.56%,AUC is 0.880,and the difference between different GM detection values is statistically significant(P<0.05).When 0.88 is the optimal cut-off for GM detection in BAALF,false positives for GM are mainly due to cryptococcal infection and the use of semisynthetic penicillins,and false negatives are due to the use of antifungals.Conclusion When the GM value in BALF is 0.88,it has the best diagnostic efficacy for IPA in patients with agranulocytosis,and the false-positive results of GM detection are closely related to the use of cryptococcal infection and semi-synthetic penicillins,and the false-negative results are closely related to the use of antifungal drugs.