支气管肺泡灌洗液G试验对肺部真菌感染的诊断价值

Diagnostic value of Bronchoalveolar lavage test for pulmonary fungal infection

目的:探讨支气管肺泡灌洗液(1,3)-β-D葡聚糖试验(G试验)对肺部真菌感染(pulmonary fungal infections,PFI)的诊断价值.方法:选取2019年7月-2019年12月我院经临床诊断或病理组织学确认的50例PFI患者作为PFI组,同时选取50例细菌性肺炎患者作为细菌性肺炎组.检测患者肺泡灌洗液(BALF)及血清中真菌(1,3)-β-D葡聚糖的浓度以及对PFI的预测效果.并进行logistic回归分析及受试者工作特征曲线(ROC)曲线分析.结果:PFI组患者真菌感染以光滑假丝酵母菌(28%)和白色假丝酵母菌(44%)为主,两组患者肺泡灌洗液中真菌(1,3)-β-D葡聚糖的浓度比较,PFI组大于细菌性肺炎组,差异具有统计学意义;ROC曲线分析显示,支气管肺泡灌洗液及血清中真菌(1,3)-β-D葡聚糖的浓度相对于细菌肺炎组曲线下面积(AUC)分别为0.9134(95%置信区间:0.8578~0.969,P<0.0001)和 0.566(95%置信区间:0.4532~0.6788,P=0.2554),敏感度分别为92.00%(46/50)、34.0%(17/50),特异度分别为 82.00%(41/50)、80.00%(40/50),约登指数分别为 0.74 和 0.14.肺泡灌洗液G试验的最佳截断值为281.3 pg/mL.结论:肺泡灌洗液G试验可以有效地区分肺部真菌感染和细菌感染.

Objective:To evaluate the diagnostic value of Bronchoalveolar lavage test in Pulmonary Fungal Infections(PFI).Motheds:50 patients with PFI confirmed by clinical diagnosis or histopathology were randomly selected as the PFI group and 50 patients with bacterial pneumonia as the bacterial pneumonia group.Specimens were collected from July 2019 to December 2019 from inpatients at Guangxi Medical University.The concentration of Fungal(1,3)-D Glucan and its predictive effect on PFI were detected by bronchoalveolar lavage in both groups.Results Logistic Regression and receiver operating characteristic curve(ROC)analysis were performed.Results:Candida GLABRATA(28%)and candida ALBICANS(44%)were the main fungal infections in PFI patients.The concentrations of Fungal(1,3)-D Glucan in lavage fluid were higher in PFI group than in bacterial pneumonia group,the differences were statistically significant,Roc Curve Analysis showed that the concentrations ofFungal(1,3)-D Glucan in serum and Bronchoalveolar lavage fluid were 0.9134(95%CI:0.8578-0.969,P<0.0001)and 0.566(95%CI:0.4532~0.6788,P=0.2554),respectively,relative to the area under the curve of bacterial pneumonia.The sensitivity and specificity were 92.00%(46/50)and 34.0%(17/50),82.00%(41/50)and 80.00%(40/50)respectively and the Yoden index were 0.74 and 0.14 respectively.The Best cut-off value of Alveolar lavage fluid g test was 281.3pg/ml.Conclusion:The Bronchoalveolar lavage g test is an effective way to dfferentiate between fungal lung infections and bacterial pneumonia.