支气管肺泡灌洗液中GM试验对非免疫功能低下病人IPA的诊断价值分析  

Diagnostic value of bronchoalveolar lavage fluid galactomannan test in immunocompromised patients with invasive pulmonary aspergillosis

作　　者：徐佳 王延君 杨鑫 赵思琪 丁芹 XU Jia;WANG Yanjun;YANG Xin;ZHAO Siqi;DING Qin(Department of Infectious Diseases,The Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221000,China)

机构地区：[1]徐州医科大学附属医院感染性疾病科,江苏徐州221000

出　　处：《安徽医药》2025年第3期604-608,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨在非免疫功能低下病人中,支气管肺泡灌洗液(BALF)及血清中半乳甘露聚糖检测(GM试验)对侵袭性肺曲霉病(IPA)的诊断价值,并确定BALF-GM试验对IPA的最优截断值。方法选择2018年9月至2022年10月徐州医科大学附属医院173例疑为肺部真菌感染的非免疫功能低下病人,分级诊断结果为确诊、临床诊断的人群纳入IPA组,结果为排除的纳入非IPA组(对照组),所有病人均进行血清及BALF-GM试验,对试验结果进行统计分析,比较其对非免疫功能低下病人IPA的诊断价值。结果在非免疫功能低下病人中,BALF-GM试验对IPA的诊断最佳截断值为0.55,灵敏度及特异度分别为91.9%、59.5%,曲线下面积(AUC)及其95%CI为0.81(0.66,0.86),血清GM试验对IPA的诊断最佳截断值为0.25,灵敏度及特异度分别为43.2%、90.4%,AUC及其95%CI为0.66(0.56,0.77)。结论在非免疫功能低下病人中,BALF-GM试验对IPA具有良好的辅助诊断作用,血清GM试验对非免疫功能低下病人IPA诊断敏感性较低,诊断作用有限。Objective To investigate the diagnostic value of galactomannan(GM)test in bronchoalveolar lavage fluid(BALF)and serum for immunocompromised patients with invasive pulmonary aspergillosis(IPA),and to determine the best cut-off value of BALF-GM test for IPA.Methods A total of 173 non-immunocompromised patients,who were suspected of pulmonary fungal infection in The Affiliated Hospital of Xuzhou Medical University from September 2018 to October 2022,were included in the study.Patients with confirmed diagnostic results and clinical diagnosis were assigned to the IPA group,while the excluded patients were assigned to the non-IPA group.Serum and BALF-GM tests were performed in all patients,and the test results were statistically analyzed and compared for the diagnostic value of BALF-GM test in non-immunocompromised patients.Results In immunocompromised patients,the best cut-off value of BALF-GM test for IPA was 0.55,the sensitivity and specificity were 91.9% and 59.5% respectively,and the area under the curve(AUC)was 0.81[95%CI:(0.66,0.86)].The best cut-off value of serum GM test for IPA was 0.25,the sensitivity and specificity were separately 43.2% and 90.4%,and AUC was 0.66[95%CI:(0.56,0.77)].Conclusion In immunocompromised patients,BALF-GM test has a good diagnostic effect on IPA,while the diagnostic sensitivity of serum-GM test to IPA is low,whose diagnostic value for IPA is limited.

关 键 词：侵袭性肺曲霉病 支气管肺泡灌洗液 免疫功能 半乳甘露聚糖试验 诊断价值 

分 类 号：R519[医药卫生—内科学]