肺泡灌洗液GM、IL-8试验在侵袭性肺曲霉病的临床诊断价值和意义

Clinical diagnostic value and significance of GM and IL-8 tests in invasive pulmonary aspergillosis

目的:探索肺泡灌洗液的GM、IL-8水平在侵袭性肺曲霉病的临床诊断价值和意义。方法:选取2021年01月~2023年04月在洛阳市中心医院住院的52例肺曲霉菌病患者为研究对象(包括确诊组10例,临床诊断组42例)。选取同期住院的93例肺部细菌性感染患者为对照组。所有住院患者均于治疗前完成支气管检查,并完成血液GM、IL-8水平和肺泡灌洗液GM、IL-8水平测定,并进行比较和诊断效能分析。结果:血清GM、肺泡灌洗液GM、血清IL-8、肺泡灌洗液IL-8水平四项指标在IPA组和非IPA组对比,U值分别为3448.500、1320.000、3922.000、3796.500,P值均小于0.001,差异有统计学意义。血清GM水平在0.365时,曲线下面积为0.713(P<0.001)(95%置信区间0.616~0.810),诊断效能最高,灵敏度59.6%,特异度81.7%;肺泡灌洗液GM水平在1.0时,曲线下面积为0.728(P<0.001)(95%置信区间0.643~0.813),诊断效能最高,灵敏度38.5%,特异度96.8%;血清IL-8水平在55.0时,曲线下面积为0.811(P<0.001)(95%置信区间0.728~0.893),诊断效能最高,灵敏度73.1%,特异度84.9%;肺泡灌洗液IL-8水平在933.5时,曲线下面积为0.785(P<0.001)(95%置信区间0.705~0.865),诊断效能最高,灵敏度50%,特异度97.8%。血清GM、肺泡灌洗液GM、血清IL-8、肺泡灌洗液IL-8水平四项指标联合诊断,灵敏度90.4%,特异度71.0%,PPV63.5%,NPV93%,约登指数0.614。结论:肺泡灌洗液GM和IL-8在IPA的诊断中具有一定的临床诊断价值,两者联合有望成为新的诊断方式。

Objective:To explore the clinical value and significance of GM and IL-8 levels in alveolar lavage fluid in the diagnosis of invasive pulmonary aspergillosis.Methods:52 patients with pulmonary aspergillus who were hospitalized in Luoyang Central Hospital from January 2021 to April 2023 were selected as the study objects(including 10 cases in the confirmed group and 42 cases in the clinical diagnosis group).93 patients with pulmonary bacterial infection who were hospitalized during the same period were selected as control group.All hospitalized patients underwent bronchial examination before treatment,and the levels of GM and IL-8 in blood and GM and IL-8 in alveolar lavage fluid were determined,and the diagnostic efficacy was compared and analyzed.Results:The U values of serum GM,alveolar lavage fluid GM,serum IL-8 and IL-8 levels in IPA group and non-IPA group were 3448.500,1320.000,3922.000 and 3796.500,respectively,with(P<0.001),and the differences were statistically significant.When the serum GM level was 0.365,the area under the curve was 0.713(P<0.001)(95%confidence interval 0.616-0.810),the diagnostic efficiency was the highest,the sensitivity was 59.6%,and the specificity was 81.7%.When the GM level of alveolar lavage fluid was 1.0,the area under the curve was 0.728(P<0.001)(95%confidence interval 0.643~0.813),indicating the highest diagnostic efficiency,sensitivity 38.5%,specificity 96.8%.When serum IL-8 level was 55.0,the area under the curve was 0.811(P<0.001)(95%confidence interval 0.728-0.893),indicating the highest diagnostic efficacy,sensitivity 73.1%,specificity 84.9%.When the level of IL-8 in alveolar lavage fluid was 933.5,the area under the curve was 0.785(P<0.001)(95%confidence interval 0.705~0.865),indicating the highest diagnostic efficacy,sensitivity of 50%and specificity of 97.8%.Serum GM,alveolar lavage fluid GM,serum IL-8,and alveolar lavage fluid IL-8 levels were combined for diagnosis,sensitivity 90.4%,specificity 71.0%,PPV63.5%,NPV93%,and Jorden index 0.614.Conclusion:The combination of GM and IL-8 has certain clinical value in the diagnosis of IPA,which is expected to become a new diagnostic method.