GM试验联合肺部CT特点在诊断IPA中的应用  

The clinical value of the combinations of galactomannan test and CT in invasive pulmonary aspergillosis

作　　者：刘元元[1] 刘利华[1] 姚树娈[2] 张楠楠[2] 孙强[3] 董海新[1] LIU Yuan-yuan;LIU Li-hua;YAO Shu-luan(Department of Clinical Laboratory,The Affiliated Hospital of Jining Medical University,Shandong Jining 272000)

机构地区：[1]济宁医学院附属医院检验科,山东济宁272000 [2]济宁医学院附属医院呼吸与重症医学科,山东济宁272000 [3]济宁医学院附属医院重症监护室,山东济宁272000

出　　处：《医学检验与临床》2024年第11期6-10,共5页Medical Laboratory Science and Clinics

基　　金：济宁市科技发展计划项目,项目编号:济科字2016-56-39。

摘　　要：目的:回顾性分析血清半乳甘露聚糖(GM)实验联合肺部多层螺旋CT(MSCT)检查对诊断侵袭性肺曲霉病(IPA)的临床价值。方法:对三甲医院1963例疑似侵袭性曲霉菌感染患者的GM试验、临床资料、MSCT影像学特点进行回顾性分析。将临床抗真菌治疗成功病例作为依据,以痰培养或活组织病理学检查结果为金标准,计算敏感性和特异性。采用受试者工作特征(ROC)曲线分析血清GM试验联合MSCT影像学检查对侵袭性肺曲霉菌感染的诊断价值。结果:1963例疑似侵袭性曲霉感染患者中,GM试验阳性和阴性病例数分别为244例、1719例,对应临床诊断为IPA病例数为149例、25例;CT表现为高密度影、磨玻璃影、结节影伴或不伴空洞形成的有875例,其他CT表现的有1088例,对应诊断为IPA病例数分别是139例、35例。GM试验的敏感性、特异性是85.6%、94.7%,CT的敏感性、特异性是79.9%、59.3%,两者联合检测可分别将敏感性、特异性提高至100%(并联)、99.6%(串联)。ROC结果显示,GM试验和CT对侵袭性曲霉菌感染均有一定的诊断价值,ROC曲线下面积分别为0.902(95%CI:0.871~0.933)、0.719(95%CI:0.683~0.755),联合检测可将诊断价值进一步提高,ROC曲线下面积为0.957(95%CI:0.942~0.972)。结论:GM阳性和阴性患者影像学均可以表现高密度影、磨玻璃影或小结节影伴或不伴空洞形成等征象,所以影像学诊断IPA没有明显特异性,而本研究数据显示GM试验联合肺部CT对IPA患者的诊断价值较高,并具有重要的临床应用价值。Objective:A retrospective analysis of the relationship between serum galactomannan(GM)test and MSCT imaging features in patients with invasive pulmonary aspergillosis(IPA).Methods:The GM test,clinical cases and MSCT imaging features of 1963 patients with suspected invasive Aspergillus infection in a tertiary hospital were analyzed retrospectively.Based on the successful cases of clinical antifungal treatment,the gold standard was sputum culture or biopsy results,the sensitivity and specificity were calculated.The diagnostic value of serum GM test combined with MSCT imaging in invasive pulmonary Aspergillus infection was analyzed by receiver operating characteristic(ROC)curve.Results:Among the 1963 patients with suspected invasive Aspergillus infection,the number of positive and negative cases of GM test were 244 and 1719 respectively,and the number of corresponding clinical diagnosis of IPA were 149 and 25;875 cases showed high-density shadow,ground glass shadow or nodule shadow with or without cavity formation on CT,1088 cases showed other CT manifestations,and the corresponding number of cases diagnosed as IPA were 139 and 35 respectively.The sensitivity and specificity of GM test were 85.6%and 94.7%,the sensitivity and specificity of CT were 79.9%and 59.3%.The combined detection of GM and CT can improve the sensitivity and specificity to 100%parallel and 99.6%(series)respectively.The results of ROC showed that GM test and CT had certain diagnostic value for invasive Aspergillus infection.The area under the ROC curve was 0.902(95%CI:0.871-0.933)and 0.719(95%CI:0.683-0.755)respectively.The diagnostic value could be further improved by combined detection.The area under the ROC curve was 0.957(95%CI:0.942-0.972).Conclusion:The imaging finding of GM positive and negative patients can show signs such as high-density shadow,ground glass shadow or small nodule shadow with or without cavity formation,so there is not obvious specificity of diagnosis of IPA with the imaging.The data of this study show that GM test combin

关 键 词：侵袭性肺曲霉菌病 曲霉菌半乳甘露聚糖试验 影像学 肺 

分 类 号：R445[医药卫生—影像医学与核医学]