血清和支气管肺泡灌洗液GM试验对非粒细胞缺乏患者不同类型肺曲霉病的诊断价值分析  

Diagnostic value of serum and bronchoalveolar lavage fluid galactomannan test in non-neutropenic patients with different types of pulmonary aspergillosis

作　　者：张传明[1] 曹泓宇 孙继德[1] 牛司强[1] 王詝[1] 蒲姝丽 徐绣宇[1] ZHANG Chuanming;CAO Hongyu;SUN Jide;NIU Siqiang;WANG Zhu;PU Shuli;XU Xiuyu(The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China)

机构地区：[1]重庆医科大学附属第一医院检验科,重庆400016

出　　处：《中国真菌学杂志》2022年第2期146-151,共6页Chinese Journal of Mycology

摘　　要：目的探讨血清和支气管肺泡灌洗液(BALF)GM试验在不同类型肺曲霉病中的诊断价值,并确定BALF GM试验对常见肺曲霉病的最优cut-off值。方法收集2017年1月至2021年3月在重庆医科大学附属第一医院诊断为肺曲霉病且同时送检过血清和BALF GM试验的非粒细胞缺乏患者资料146例,其中侵袭性肺曲霉病(invasive pulmonary aspergillosis,IPA)97例,慢性肺曲霉病(chronic pulmonary aspergillosis,CPA)39例,变应性支气管肺曲霉病(allergic bronchopulmonary aspergillosis,ABPA)10例;并随机选取132例同时期患有其他类型肺部疾病者作为对照组。统计分析血清和BALF GM试验对不同类型肺曲霉病的诊断性能。结果在非粒细胞缺乏患者中,BALF GM试验对IPA和CPA诊断的最优cut-off值分别为1.0和0.91,敏感性分别为74.2%和74.4%,特异性分别为83.3%和81.1%,但对ABPA的诊断作用有限(AUC=0.648);在cut-off值为0.5时,血清GM试验对IPA和CPA的诊断敏感性分别为41.2%和10.3%,对ABPA的诊断价值较差(AUC<0.5)。结论在非粒细胞缺乏患者中,BALF GM试验对IPA和CPA的诊断均有良好辅助诊断作用,但对ABPA的诊断作用有限;血清GM试验对IPA和CPA的诊断敏感性较低,对ABPA的诊断价值更差。Objective To investigate the diagnostic value of serum and bronchoalveolar lavage fluid(BALF)galactomannan(GM)test in different types of pulmonary aspergillosis,and to determine the best cut-off value of BALF GM test for different pulmonary aspergillosis.Methods From January 2017 to March 2021,clinical data of 146 non-neutropenic patients diagnosed with pulmonary aspergillosis who underwent serum and BALF GM test in the First Affiliated Hospital of Chongqing Medical University were collected,including 97 cases of IPA,39 cases of CPA and 10 cases of ABPA.132 patients with other lung diseases in the same period were randomly selected as the control group.The diagnostic performance of serum and BALF GM test for different types of pulmonary aspergillosis was analyzed.Results In non-neutropenic patients,the best cut-off values of BALF GM test for IPA and CPA were 1.0 and 0.91,the sensitivity were 74.2%and 74.4%,and the specificity were 83.3%and 81.1%,respectively.However,the diagnostic value of BALF GM test for ABPA was limited(AUC=0.648).At a cut-off value of 0.5,the diagnostic sensitivity of serum GM test for IPA and CPA was 41.2%and 10.3%,respectively,and the diagnostic value for ABPA was even worse(AUC<0.5).Conclusion In non-neutropenic patients,BALF GM test has a good diagnostic effect on IPA and CPA,but its diagnostic effect on ABPA is limited.The diagnostic sensitivity of serum GM test to IPA and CPA is low,and its diagnostic value of ABPA is worse.

关 键 词：肺曲霉病 支气管肺泡灌洗液 GM试验 诊断价值 

分 类 号：R519.8[医药卫生—内科学] R563[医药卫生—临床医学]