非粒细胞缺乏患者侵袭性肺曲霉菌感染的早期诊断价值  

Early diagnostic value of galactomannan test to invasive pulmonary aspergillosis in patients with non- neutropenia

作　　者：周建林[1] 曹颖平[1] 张晓琍[1] 张丽华[1] 王梅华[1] Zhou Jianlin;Cao Yingping;Zhang Xiaoli;Zhang Lihua;Wang Meihua(Department of Clinical Laboratory,the Union Hospital of Fujian Medical University,Fuzhou 350000,China)

机构地区：[1]福建医科大学附属协和医院检验科,福州350000

出　　处：《中华检验医学杂志》2018年第11期837-840,共4页Chinese Journal of Laboratory Medicine

基　　金：福建省科技创新联合基金（2017Y9051）;福建省卫生计生科研人才项目（2017-CX-20,2018-CX-19）

摘　　要：目的探讨支气管肺泡灌洗液（BALF）半乳甘露聚糖（GM）试验对非粒细胞缺乏患者侵袭性肺曲霉菌感染（IPA）的早期诊断价值。方法收集2016年1月至2017年10月福建医科大学附属协和医院重症医学科与呼吸科怀疑IPA的患者199例，排除粒细胞缺乏。根据欧洲癌症研究和治疗组织／侵袭性真菌感染协作组和美国国立变态反应和感染病研究院真菌病研究组共识分为IPA组和非IPA组。分别采集两组患者的BALF和血清行GM试验。用SPSS20．0统计学软件对IPA组和非IPA组结果进行统计分析。结果IPA组的BALF和血清GM指数（I）值分别为2．41±2．19和0．65±1．08，差异有统计学意义（u=8．27，P〈0．0005）。非IPA组的BALF和血清GMI值分别为0．37±0．33和0．2±0．15，与IPA组比较，差异均有统计学意义（u=11.18和7．07，P〈0．0005）。当I≥0．5为阳性阈值时，BALFGM检测的敏感度、阳性预测值和阴性预测值分别为86．36％、74．02％和92．62％，均高于血清GM试验（分别为31．8％、67．74％和73．21％）。BALFGM检测的特异性为84．96％，低于血清GM试验（92．48％）；当I≥1．0为阳性阈值时，BALFGM检测的敏感度、阳性预测值和阴性预测值分别为66．66％、84．61％和85．03％，仍都高于血清GM试验（分别为24．24％、76．19％和71．9％），而特异度方面两者相近（95．98％和96．24％）。结论在非粒细胞缺乏的IPA患者中，BALFGM检测具有较高的敏感性和特异性，优于血清GM试验，在其早期诊断中具有重要价值。Objective To evaluate the early diagnostic value of galactomannan （GM） test in bronchoalveolar lavage fluid （BALF）to invasive pulmonary aspergillosis （IPA） in patients with non- neutropenia. Methods A total of 199 patients with suspected IPA were enrolled in the Department of Critical Care Medicine and Respiration of the Union Hospital of Fujian Medical University from January 2016 to October 2017, these patients excluded neutropenia. The patients were divided into IPA group and non-IPA group according to the European Organization for Research and Treatment of Cancer/Infectious Diseases Mycoses Study Group （EORTC/MSG）consensus. BALF and serum GM tests were performed in both groups. SPSS 20.0 statistical software was used to analyze the results of both IPA group and non-IPA group. Results The GM index in BALF and serum of IPA group was 2.41 ± 2. 19 and 0. 65± 1.08 respectively. The former is higher than the latter, the difference was statistically significant （ u = 8.27, P 〈 0.000 5）. The GM index in BALF and serum of non-IPA group was 0.37±0.33 and 0.2±0.15 respectively, compared with the IPA group, the difference were statistically significant （u = 11. 18 and 7. 07, P 〈 0. 000 5 ）. When the cut-off of GM was equal or greater than 0. 5, the sensitivity, positive predictive value and negative predictive value of GM test in BALF was 86. 36%, 74. 02% and 92. 62% respectively, were significantly higher than those in serum（31.8% , 67.74% and 73.21% respectively）. The specificity of GM test in BALF was 84. 96% , which was lower than that in serum（92.48% ）. When the cut-off of GM was equal or greater than 1.0, the sensitivity, positive predictive value and negative predictive value of GMtest in BALF was 66. 66%, 84. 61% and 85.03% respectively, significantly higher than those in serum （24.24%, 76. 19% and 71.9% respectively）. The specificity was similar （95.98% vs 96.24%）. Conclusions GM test in BALF has a highly sensitivity and specificity in patients with non-neutropenia

关 键 词：侵袭性肺曲霉菌病 支气管肺泡灌洗液 甘露聚糖类 早期诊断 

分 类 号：R519[医药卫生—内科学]