支气管肺泡灌洗液隐球菌荚膜多糖抗原胶体金法对肺隐球菌病的诊断价值  

The diagnostic value of cryptococcal antigen lateral flow immunochromatographic assay in bronchoalveolar lavage fluid among patients with pulmonary cryptococcosis

作　　者：曾惠清[1,2] 蔡雪莹 张孝斌[1] 杨栋勇[3] 林立[4] 陈美珺[5] 郭伟峰[6] 朱思虹[2] 陈享星 陈小蓉 黄叶梅 ZENG Huiqing;CAI Xueying;ZHANG Xiaobin;YANG Dongyong;LIN Li;CHEN Meijun;GUOWeifeng;ZHU Sihong;CHEN Xiangxing;CHEN Xiaorong;HUANG Yemei(Department of Pulmonary and Critical Care Medicine,Zhongshan Hospital,Xiamen University,Xiamen,Fujian 361004,P.R.China;Department of Clinical Medicine,Fujian Medical University,Fuzhou,Fujian 350001,P.R.China;Department of Pulmonary and Critical Care Medicine,Second Affiliated Hospital of Fujian Medical University,Quanzhou,Fujian 362006,P.R.China;Department of Pulmonary and Critical Care Medicine,Zhangzhou Municipal Hospital of Fujian Medical University,Zhangzhou,Fujian 363002,P.R.China;Clinical Laboratory Center,Zhongshan Hospital,Xiamen University,Xiamen,Fujian 361004,P.R.China;Department of Pulmonary and Critical Care Medicine,Quanzhou First Hospital of Fujian Medical University,Quanzhou,Fujian 362003,P.R.China)

机构地区：[1]厦门大学附属中山医院呼吸与危重症医学科,福建厦门361004 [2]福建医科大学临床医学部,福建福州350001 [3]福建医科大学附属第二医院呼吸与危重症医学科,福建泉州362006 [4]福建医科大学附属漳州市立医院呼吸与危重症医学科,福建漳州363002 [5]厦门大学附属中山医院临床检验中心,福建厦门361004 [6]福建医科大学附属泉州第一医院呼吸与危重症医学科,福建泉州362003

出　　处：《中国呼吸与危重监护杂志》2020年第3期258-263,共6页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：福建省科技厅科技计划引导性项目(2017D0016)。

摘　　要：目的探讨支气管肺泡灌洗液(BALF)中的隐球菌荚膜多糖抗原胶体金免疫层析法(CrAg-LFA)检测对肺隐球菌病的诊断价值。方法应用前瞻性研究方法收集2015年3月至2018年10月厦门大学附属中山医院、福建医科大学附属第二医院、福建医科大学附属漳州市立医院、福建医科大学附属泉州第一医院4家住院患者,经肺组织活检病理确认的非人类免疫缺陷病毒感染患者分为肺隐球菌病组72例,非肺隐球菌病组236例。患者均行血清和BALF CrAg-LFA检测及微生物培养。结果肺隐球菌病组中,血清CrAg-LFA阳性54例,阴性18例,培养隐球菌阳性1例,阴性71例;BALF CrAg-LFA阳性67例,阴性5例,涂片或培养隐球菌阳性9例,阴性63例。非肺隐球菌病组中,血清CrAg-LFA弱阳性1例,阴性235例;血清培养97例,无隐球菌生长;BALF CrAg-LFA检测236例,均阴性,培养121例,无隐球菌生长。血清CrAg-LFA检测的敏感性为75.0%,特异性为99.6%,阳性预测值为98.2%,阴性预测值为92.9%;BALF CrAg-LFA检测的敏感性为93.6%,特异性为100.0%,阳性预测值为100.0%,阴性预测值为97.9%。肺隐球菌病组BALF CrAg-LFA检测的敏感性高于血清,差异有统计学意义(χ2=8.745,P<0.05)。结论CrAg-LFA检测快速、简单,对肺隐球菌病的诊断BALF比血清有更大的临床意义,BALF CrAg-LFA阳性结果等同于微生物学阳性的诊断价值。Objective To evaluate the diagnostic value of cryptococcal antigen lateral flow immunochromatographic assay(CrAg-LFA)in bronchoalveolar lavage fluid(BALF)among pulmonary cryptococcosis(PC)patients.Methods Patients from the Zhongshan Hospital,Xiamen University,Zhangzhou Municipal Hospital of Fujian Medical University,Second Affiliated Hospital of Fujian Medical University,and Quanzhou First Hospital of Fujian Medical University were enrolled prospectively from March 2015 to October 2018.They were confirmed without human immunodeficiency virus infection and were divided into non-PC group(236 cases)and PC group(72 cases).The PC was definitely diagnosed by histopathological evidence from lung biopsy.The CrAg-LFA and culture were performed in both the serum and BALF among the enrolled patients.Results Among 72 PC patients,54 had a positive serum CrAg-LFA,1 had positive serum culture;67 patients had a positive BALF CrAg-LFA,9 had positive BALF culture.Among the non-PC group,only 1 patient had a weak positive serum CrAg-LFA,none had positive serum culture of PC;236 cases non-PC patients underwent BALF CrAg-LFA detection,none had a positive BALF CrAg-LFA;none of the 121 cases who had BALF culture yielded a positive result in PC.The sensitivity,specificity,positive predicted value,and negative predicted value in serum were 75.0%,99.6%,98.2%,and 92.9%,respectively.Those above mentioned values in the BALF yielded 93.6%,100.0%,100.0%,and 97.9%,respectively.Among the PC group,the sensitivity was higher in BALF than that in serum(χ2=8.745,P<0.05).Conclusions The CrAg-LFA is a simple and rapid diagnostic method for PC.The diagnostic value of CrAg-LFA in the BALF is superior to that in serum and fungal culture among the PC patients.The positive BALF CrAg-LFA result is consistent with mycological positive results.

关 键 词：胶体金法 隐球菌荚膜多糖抗原 支气管肺泡灌洗液 肺隐球菌病 

分 类 号：R519.4[医药卫生—内科学]