支气管肺泡灌洗液半乳甘露聚糖检测在COVID-19相关侵袭性肺部真菌感染中的诊断价值

Diagnostic value of galactomannan detection in bronchoalveolar lavage fluid in COVID-19 associated invasive pulmonary fungal infection

目的分析支气管肺泡灌洗液(BALF)中半乳甘露聚糖(GM)的浓度及其在诊断新型冠状病毒感染(COVID-19)相关侵袭性肺部真菌感染(IPFI)中的价值。方法以2022至2023年安徽医科大学第一附属医院收治的COVID-19患者确诊、临床诊断或拟诊断的COVID-19相关IPFI 41例为试验组,以同期收治的42例单纯肺炎患者为对照组。两组患者均行支气管镜肺泡灌洗术,同时检测患者BALF和血清的GM含量,分析两组不同标本检测方法的GM浓度差异和临床诊断价值,评价其诊断效能,绘制ROC曲线。结果试验组患者BALF-GM浓度[(2.27±1.78)ng/L vs(0.51±0.28)ng/L,t=6.329,P<0.01]及血清GM浓度[(1.57±0.56)ng/L vs(0.32±0.11)ng/L,t=14.190,P<0.01]均比对照组高,差异有统计学意义。BALF诊断IPFI的最佳截断值为1.82 ng/L,敏感性和特异性分别为77.9%和89.2%,AUC为0.92(95%CI:0.871~0.955);血清最佳截断值为0.67 ng/L,敏感性和特异性分别为64.9%和92.2%,AUC为0.89(95%CI:0.854~0.925)。然而BALF的假阳性率略高于血清(10.8%vs 7.8%)。结论GM可以作为较好的评估COVID-19相关IPFI的指标。BALF中的GM检测对IPFI诊断比血清更具有临床价值。

Objective To analyze the concentration of galactomannan(GM)in bronchoalveolar lavage fluid(BALF)and its value in the diagnosis of COVID-19 related invasive pulmonary fungal infection(IPFI).Methods From 2022 to 2023,41 patients with COVID-19 related IPFI comfimed,clinically diagnosed or to be diagnosed in the First Affiliated Hospital of Anhui Medical University were taken as the experimental group,and 42 patients with simple pneumonia were taken as the control group.Bronchoscopic alveolar lavage was performed in both groups,and the contents of GM in both BALF and serum were detected at the same time.The concentration difference and clinical diagnostic value of GM between the two groups of different specimens were analyzed,and ROC was used to evaluate the diagnostic efficacy.Results Compared with the control group,the experimental group had higher BALF GM concentrations[(2.27±1.78)ng/L vs(0.51±0.28)ng/L,t=6.329,P<0.01]and serum GM concentrations[(1.57±0.56)ng/L vs(0.32±0.11)ng/L,t=14.190,P<0.01].The optimal cut-off value for diagnosing IPFI with BALF was 1.82 ng/L,with sensitivity and specificity of 77.9%and 89.2%,respectively,and AUC of 0.92(95%CI:0.871-0.955).The optimal cut-off value for serum was 0.67 ng/L,with sensitivity and specificity of 64.9%and 92.2%,respectively,and AUC of 0.89(95%CI:0.854-0.925).However,the false positive rate of BALF was slightly higher than that of serum(10.8%vs 7.8%).Conclusion GM can be serve of as a good indicator for evaluating IPFI related to COVID-19.The GM detection in BALF has more clinical value in the diagnosis of IPFI than serum.