血清半乳甘露聚糖和曲霉IgG对肺曲霉菌病感染的诊断价值  

Values of serum galactomannan and Aspergillus immunoglobulin G in diagnosis of pulmonary aspergillosis

作　　者：胡小燕 李森华 胡志明 高丽萍 陈小英 HU Xiao-yan;LI Sen-hua;HU Zhi-ming;GAO Li-ping;CHEN Xiao-ying(Hangzhou Ninth People's Hospital,Hangzhou,Zhejiang 311225,China;不详)

机构地区：[1]杭州市第九人民医院呼吸内科,浙江杭州311225 [2]丽水市第二人民医院呼吸内科,浙江丽水323000

出　　处：《中华医院感染学杂志》2022年第14期2090-2093,共4页Chinese Journal of Nosocomiology

基　　金：杭州市医药卫生科技基金资助项目(OO20190746)。

摘　　要：目的探讨血清半乳甘露聚糖(GM)、曲霉免疫球蛋白G(IgG)在肺曲霉菌病(PA)的诊断价值。方法选取2017年3月-2020年3月杭州市第九人民医院呼吸内科98例疑似PA患者为研究对象,病原学诊断其中61例肺曲霉菌感染病患者为研究组,包含25例侵袭性肺曲霉菌病(IPA)和36例慢性肺曲霉菌病(CPA),并设为IPA组和CPA组,37例非肺曲霉菌感染病患者为对照组。统计病原学诊断结果及不同PA感染类型血清GM、曲霉IgG水平,绘制受试者工作特征曲线(ROC)分析诊断价值,Logistic回归模型分析各指标诊断肺曲霉菌感染的影响因素,同时统计各指标指导抗菌药物应用的有效性。结果CPA组血清GM、曲霉IgG水平高于IPA组、对照组(P<0.05);ROC显示,联合诊断肺曲霉菌感染价值的曲线下面积(AUC)优于曲霉IgG、GM(P<0.05),敏感度及特异度分别为78.69%、83.78%;免疫状态低下、合并肺炎、合并肺结核、合并COPD是影响血清GM、曲霉IgG诊断肺曲霉感染价值的危险因素(P<0.05)。结论GM、IgG在PA患者外周血中特异性表达,但其表达水平受多种因素影响,二者联合检测可弥补彼此缺陷,有助于PA早期确诊。OBJECTIVE To explore the value of serum galactomannan(GM) and Aspergillus immunoglobulin G(IgG) in diagnosis of pulmonary aspergillosis(PA). METHODS A total of 98 patients with suspected PA who were treated in respiratory medicine department of Hangzhou Ninth People’s Hospital from Mar 2017 to Mar 2020 were recruited as the study subjects, 61 of whom were etiologically diagnosed with pulmonary Aspergillus infection and were assigned as the study group, including 25 cases of invasive pulmonary aspergillosis(IPA) and 36 cases of chronic pulmonary aspergillosis(CPA). Totally 37 patients without pulmonary Aspergillus infection were chosen as the control group. The results of etiological test were statistically analyzed, the levels of serum GM and Aspergillus IgG were observed and compared among the patients with different types of PA infection, receiver operating characteristic(ROC) curves were drawn to analyze the diagnostic values, and logistic regression analysis was performed for influencing factors of the indexes for diagnosis of pulmonary Aspergillus infection, and the effectiveness of the indexes in guiding the use of antibiotics was statistically analyzed. RESULTS The levels of serum GM and Aspergillus IgG of the CPA group were significantly higher than that of the IPA group and the control group(P<0.05). ROC curve analysis showed that the area under the curve(AUC) of the joint detection of Aspergillus IgG and GM was significantly better than that of the single Aspergillus IgG and GM(P<0.05), the sensitivity and specificity were 78.69% and 83.78%, respectively. Immunocompromised state, complication with pneumonia, complication with pulmonary tuberculosis and complication with COPD were the risk factors for affecting the value of serum GM and Aspergillus IgG in diagnosis of pulmonary Aspergillus infection(P<0.05). CONCLUSION The PA patients show specific expressions of GM and IgG in peripheral blood, which are affected by multiple factors. The joint detection of the two indexes may make up for each other’s

关 键 词：半乳甘露聚糖 免疫球蛋白G 曲霉菌 肺曲霉菌病 抗菌药物 受试者工作特征曲线 诊断 

分 类 号：R519.3[医药卫生—内科学]