支气管肺泡灌洗液多指标联合诊断在侵袭性肺部真菌感染中的应用价值

Application value of multi-indexes combined diagnostic of broncho-alveolar lavage fluid in invasive pulmonary fungal infection

目的评价支气管肺泡灌洗液(BALF)多种真菌检测方法在侵袭性肺部真菌感染(IPFIs)诊断中的效能,探讨联合诊断的优势。方法回顾性分析2023年1月至12月261例疑似IPFIs住院患者的BALF真菌培养、真菌荧光染色、1,3-β-D葡聚糖检测(G试验)和半乳甘露聚糖检测(GM试验)结果。依据诊断结果,将所有受试者分为真菌感染组(87例)与对照组(174例)。以临床诊断为金标准,采用受试者工作特征(ROC)曲线评估各方法的诊断效能。结果两组合并细菌感染情况比较,差异具有统计学意义(P<0.05)。真菌培养、真菌荧光染色、G试验、GM试验的曲线下面积(AUC)分别为0.730、0.862、0.766、0.708,差异具有统计学意义(P<0.05)。G试验与GM试验联合诊断IPFIs的AUC为0.826,优于G试验、GM试验单独诊断(P<0.05),但与四种方法联合诊断的AUC(0.891)比较,差异无统计学意义(P>0.05)。结论BALF真菌荧光染色和G试验对IPFIs的诊断效能较高,且多指标联合诊断优于单一诊断。

Objective To evaluate the efficacy of multiple fungal detection methods in bronchoalveolar lavage fluid(BALF)in the diagnosis of invasive pulmonary fungal infections(IPFIs),and to explore the advantages of combined diagnosis.Methods The results of BALF fungal culture,fungal fluorescence staining,1,3-β-D glucan test(G test)and galactomannan test(GM test)in 261 hospitalized patients with suspected IPFIs from January to December 2023 were retrospectively analyzed.According to the diagnostic results,all subjects were divided into fungal infection group(87 cases)and control group(174 cases).With clinical diagnosis as the gold standard,the receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of each method.Results There was a statistically significant difference in the bacterial infection between the two groups(P<0.05).The area under the curve(AUC)of fungal culture,fungal fluorescence staining,G test,and GM test were 0.730,0.862,0.766 and 0.708,respectively,and the difference was statistically significant(P<0.05).The AUC of the combination of G test and GM test for diagnosing IPFIs was 0.826,which was superior to the separate diagnosis of G test and GM test(P<0.05),however,compared with the AUC(0.891)of the combination of the four methods,the difference was not statistically significant(P>0.05).Conclusion The diagnostic efficacy of BALF fungal fluorescence staining and G test for IPFIs are high,and the combined diagnosis of multi-indexes is better than single diagnosis.