血清IL-17联合血清GM试验和BALF-GM试验对ICU侵袭性肺曲霉菌病的诊断价值  

Diagnostic value of serum IL-17 combined serum GM test and BALF-GM test for invasive pulmonary aspergillosis in ICU

作　　者：白吉佳 郑磊 李刚[1] 尹磊[1] 丁欢[1] BAI Jijia;ZHENG Lei;LI Gang;YIN Lei;DING Huan(Intensive Care Unit,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Anesthesiology,Shizuishan Second People′s Hospital,Shizuishan 753000,China)

机构地区：[1]宁夏医科大学总医院重症医学科,宁夏银川750004 [2]石嘴山市第二人民医院麻醉科,宁夏石嘴山753000

出　　处：《宁夏医学杂志》2024年第9期750-753,F0003,共5页Ningxia Medical Journal

基　　金：宁夏回族自治区卫生健康委科研项目(202025610);宁夏医科大学校级项目(XM2020143)。

摘　　要：目的通过监测ICU内具有真菌侵袭高风险的肺部感染患者血清IL-17水平、血清半乳甘露聚糖(GM)试验及肺泡灌洗液(BALF)-GM试验变化,探索联合检测对于早期诊断ICU侵袭性肺曲霉病(IPA)的价值。方法选择60例肺部感染且具有真菌感染相关危险因素的患者,将其分为2组,试验组为确诊+临床诊断IPA组(30例);对照组为拟诊IPA组(30例)。分别进行年龄、危重度评分、血常规(淋巴细胞绝对值)、血清IL-17水平、血清GM试验、BALF-GM试验、BALF真菌培养鉴定和细胞学检测以及肺部影像学检查,并采集数据。应用电化学发光法检测各组血清IL-17水平,采用酶联免疫吸附试验进行GM试验检测。应用logistic回归分析及绘制受试者工作特征曲线(ROC),分析血清IL-17水平、血清GM试验以及BALF-GM试验诊断IPA的效能;进一步评估3种指标联合检测对早期诊断IPA的效能。两两指标联合为血清GM试验联合BALF-GM试验、血清IL-17联合血清GM试验、血清IL-17联合BALF-GM试验。结果试验组患者血清IL-17、血清GM试验以及BALF-GM试验水平均明显高于对照组(P<0.05);logistic回归分析及ROC曲线分析结果显示,血清IL-17联合BALF-GM试验对IPA诊断的灵敏度为86.7%,特异度为80.0%,曲线下面积为0.852,高于血清IL-17联合血清GM及血清GM联合BALF-GM检测。结论IPA患者血清IL-17高表达,且与BALF-GM试验联合检测,能提升IPA的早期诊断价值。Objective To explore the value of combined detection for early diagnosis of invasive pulmonary aspergillosis(IPA)in ICU by monitoring the changes of serum IL-17 level,serum GM test and bronchoalveolar lavage fluid(BALF)-GM test in patients with pulmonary infection at high risk of fungal invasion in ICU.Methods Sixty patients with pulmonary infection and risk factors related to fungal infection were divided into two groups,and the test group was confirmed and clinically diagnosed IPA group of 30 cases.The control group was proposed IPA group of 30 cases.Age,severity score,blood routine(absolute lymphocyte count),serum IL-17,serum GM test,BALF-GM test,BALF fungal culture identification and cytological examination,and pulmonary imaging were performed,followed by data collection.The serum IL-17 levels in each group were measured using electro-chemiluminescence,and the GM test was performed using enzyme-linked immunosorbent assay.Logistic regression analysis and receiver operating characteristic(ROC)curve were used to analyze the diagnostic efficacy of serum IL-17,serum GM test,and BALF-GM test for IPA,and further evaluate the diagnostic efficacy of the combined testing of the three indicators for early diagnosis of IPA.The combinations of two indicators:serum GM test+BALF-GM test,serum IL-17+serum GM test,and serum IL-17+BALF-GM test.Results The levels of serum IL-17,serum GM test and BALF-GM test in the experimental group were significantly higher than those in the control group(P<0.05);logistic regression analysis and ROC curve analysis showed that the sensitivity and specificity of serum IL-17 combined with BALF-GM test for IPA diagnosis was 86.7%and the specificity was 80.0%,and the area under the curve was 0.852.It was higher than serum IL-17 combined with serum GM and serum GM combined with BALF-GM.Conclusion Serum IL-17 levels are highly expressed in IPA patients and combined with the BALF-GM test can enhance the early diagnostic value of IPA.

关 键 词：IL-17 血清GM试验 BALF-GM试验 侵袭性肺曲霉病(IPA) 诊断 

分 类 号：R519[医药卫生—内科学]