血清烟曲霉IgG、G试验及半乳甘露聚糖对慢性肺曲霉病的诊断价值  

Diagnostic value of serum Aspergillus fumigatus IgG, serum G test and serum galactomannan in chronic pulmonary aspergillosis

作　　者：李天义[1] 汤春梅[1] 潘育文[1] 肖海浩[1] 苏雯婕[1] LI Tianyi;TANG Chunmei;PAN Yuwen;XIAO Haihao;SU Wenjie(The Third District of Internal Medicine,Guangzhou Chest Hospital,Guangzhou 510095,China)

机构地区：[1]广州市胸科医院内科三区,广东广州510095

出　　处：《分子影像学杂志》2022年第3期442-446,共5页Journal of Molecular Imaging

基　　金：广州市中医药和中西医结合科技项目(20222A010038);广州市医学重点学科(2021-2023);广州市高水平临床重点专科(穗卫函[2019]1555号)。

摘　　要：目的 探讨血清烟曲霉IgG、真菌(1-3)-β-D葡聚糖(血清G试验)及血清半乳甘露聚糖(GM)检测对慢性肺曲霉病(CPA)的诊断价值。方法 选取疑似CPA的肺病患者114例,根据最终确诊情况,将确诊CPA的67例患者作为研究组,确诊为非CPA的47例患者作为对照组。采集两组患者血清,比较两组烟曲霉IgG、血清G试验、血清GM含量,并统计单个指标及联合指标诊断CPA的敏感度、特异性、准确率、阳性预测值、阴性预测值;采用MedCalc软件对各指标及其联合检测指标进行ROC曲线分析。结果 研究组患者的烟曲霉IgG、血清G试验及血清GM含量高于对照组差异有统计学意义(P<0.05);单个指标诊断CPA中,烟曲霉IgG的敏感度高于血清G试验和血清GM(P<0.001),血清G试验与血清GM的敏感度差异无统计学意义(P=0.351);但烟曲霉IgG特异性最低,血清GM特异性最高,两两比较差异有统计学意义(P<0.001)。并联试验联合指标诊断的敏感度均有提升,特异性均下降,且对相对单个指标差异无统计学意义(P>0.05);烟曲霉IgG的准确率、阴性预测值高于血清G、血清GM、血清G+血清GM(P<0.001),与其他联合检测比较差异无统计学意义(P>0.05);血清GM的阳性预测值高于其他指标(P<0.001)。ROC曲线分析烟曲霉IgG最佳临界点对应的所有检测指标与医院标准相比差异无统计学意义(P>0.05);血清G与血清GM检测CPA的最佳临界点对应的敏感度均高于医院标准,特异性低于医院标准,且准确率、阳性预测值及阴性预测值等高于医院标准(P<0.05);联合检测对应的敏感度、阴性预测值均高于医院标准,特异性低于医院标准(P<0.05);ROC曲线分析各指标曲线下面积差异有统计学意义(P<0.01),但两两比较差异均无统计学意义(P>0.05)。结论 血清烟曲霉IgG诊断CPA具有较高的敏感度,但特异性相对较低。临床可进一步依靠血清GM指标来避免假阴性。Objective To explore diagnostic value of serum Aspergillus fumigatus Ig G,(1-3)-β-D-glucan(serum G test) and serum galactomannan(GM) test in chronic pulmonary aspergillosis(CPA). Methods A total of 114 patients with pulmonary disease suspected of CPA were selected. According to the final diagnosis, 67 patients with CPA were selected as the study group and 47 patients with non CPA were selected as the control group. The sera of the two groups were collected. The Aspergillus fumigatus Ig G and serum G test, serum GM conten were compared between the two groups. The sensitivity,specificity, accuracy, positive predictive value, negative predictive value of single index and combined index in the diagnosis of CPA were counted. The ROC curve of each index and its joint detection index was analyzed by medcalc software. Results There were significant differences of Aspergillus fumigatus Ig G, serum G test and serum GM content between the two groups(P<0.05). In the diagnosis of CPA by single index, the sensitivity of Aspergillus fumigatus Ig G was significantly higher than that of serum G test and serum GM(P<0.001). There was no significant difference between serum G test and serum GM(P=0.351), but the Aspergillus fumigatus Ig G specificity was the lowest and the serum GM specificity was the highest. There was significant difference between the three index(P<0.001). The sensitivity and specificity of combined with parallel test indexes were improved and decreased, and there was no significant difference to a single index(P>0.05). The accuracy and negative predictive value of Ig G of Aspergillus fumigatus were significantly higher than those of serum G, serum GM and serum G +serum GM(P<0.001). There was no significant difference compared with other combined tests(P>0.05). The positive predictive value of serum GM was significantly higher than that of other indexes(P<0.001). ROC curve analysis showed that there was no significant difference in all detection indexes corresponding to the best critical point of Aspergillus fumi

关 键 词：慢性肺曲霉病 烟曲霉IgG 曲霉菌半乳甘露聚糖 (1-3)-β-D葡聚糖 诊断 

分 类 号：R519[医药卫生—内科学]