支气管肺泡灌洗术GM检测对非粒细胞缺乏患者肺曲霉病的诊断效果  

Study on the diagnosis of pulmonary aspergillosis in patients with non-granulocyte deficiency by GM detection of bronchial alveolar lavage

作　　者：王丽英[1] 李玲春[1] 张雪 李梦 Wang Liying;Li Lingchun;Zhang Xue;Li Meng(Department of Respiratory,Chengdu Western Hospital,Chengdu 610036,China)

机构地区：[1]成都市西区医院呼吸科,610036

出　　处：《中国医师杂志》2018年第8期1194-1196,共3页Journal of Chinese Physician

摘　　要：目的探讨支气管肺泡灌洗术半乳甘露聚糖(GM)检测对非粒细胞缺乏患者肺曲霉病的诊断效果。方法选取本院2016年5月至2017年5月收治的疑似侵袭性肺曲霉病患者64例为研究对象。根据相关诊断标准分为确诊组、临床诊断组、拟诊组和非真菌感染组。所有研究对象均行支气管肺泡灌洗术,并进行GM检测。结果确诊3例,临床诊断20例,拟诊14例,非真菌感染27例。支气管肺泡灌洗液及血清GM界值从0.5上升为1.0时,灵敏度均下降,而特异度、阳性预测值均上升。在相同GM界值时,支气管肺泡灌洗液GM检测方法灵敏度、阳性预测值和阴性预测值均显著高于血清GM检测(P<0.05),特异度显著低于血清GM检测(P<0.05)。支气管肺泡灌洗液GM界值≥0.86时,对侵袭性肺曲霉病的诊断效率最高,其灵敏度为80.26%,特异度为75.15%,曲线下面积为0.945(95%CI:0.782-0.986)。结论支气管肺泡灌洗液GM检测较血清GM检测更有助于非粒细胞缺乏患者侵袭性肺曲霉病的诊断,其最佳阈值为0.86。ObjectiveTo evaluate the diagnostic effect of galactomannan （GM） on bronchial alveolar lavage in patients with non-granulocyte deficiency.Methods64 patients with suspected invasive pulmonary aspergill were enrolled in our hospital from May 2016 to May 2017. According to the relevant diagnostic criteria, they were divided into the diagnosis group （n=3）, the clinical diagnosis group （n=20）, the proposed group （n=14） and non-fungal infection group （n=27）. All subjects underwent bronchial alveolar lavage and GM testing.ResultsWhen the GM value of bronchoalveolar lavage fluid and serum GM value increased from 0.5 to 1, the sensitivity decreased, while the specificity and positive predictive value increased. The sensitivity, positive predictive value and negative predictive value of GM detection method for bronchial alveolar lavage fluid were significantly higher than that of serum GM （P〈0.05） at the same GM boundary value, and the specificity was significantly lower than that of serum GM （P〈0.05）. When the GM boundary value of bronchial alveolar lavage fluid was ≥ 0.86, the diagnostic efficiency of invasive pulmonary aspergillosis was the highest, the sensitivity and specificity reached 80.26%, 75.15%, and the area under the curve was 0.945 （95% CI： 0.782-0.986）.ConclusionsGM detection of bronchial alveolar lavage fluid is more helpful for the diagnosis of invasive pulmonary aspergillosis in patients with non-granulocyte deficiency than serum GM. The optimal threshold is 0.86.

关 键 词：支气管肺泡灌洗 甘露聚糖类/分析 肺曲菌病/诊断 

分 类 号：R519[医药卫生—内科学]