摘要
目的 探讨血清和支气管肺泡灌洗液(BALF)半乳甘露聚糖(GM)检测对非中性粒细胞减少患者侵袭性肺曲霉菌病(IPA)的诊断价值。方法 回顾性分析2020年4月至2023年4月诊治的104例患者,其中IPA组37例,非IPA组67例,检测比较患者BALF和血清GM水平,分析BALF和血清GM检测的相关性,受试者工作特征(ROC)曲线确定BALF GM检测的临界值,并比较两种检测的诊断效能。结果 IPA组BALF和血清GM值高于非IPA组,不同基础疾病患者BALF和血清GM水平无明显差异。BALF GM的临界值为0.87,灵敏度为91.7%,特异度为92.5%,Youden指数为0.842。IPA患者BALF GM阳性率高于血清GM(χ^(2)=42.659,P<0.001)。Pearson分析显示,IPA组BALF和血清GM呈较弱正相关(r=0.296,95%CI:0.170~0.412,P<0.001)。BALF GM灵敏度为91.7%,特异度为92.5%;血清GM灵敏度为16.7%,特异度为98.5%;双阳性的灵敏度为8.3%,特异度为99.3%;BALF和血清任一阳性的灵敏度为99.6%,特异度为91.8%。结论 BALF GM检测的临界值为0.87,对IPA的诊断灵敏度高于血清GM检测,不同的组合可以侧重于提高检测的灵敏度或特异度。
Objective To explore the diagnostic value of serum and bronchoalveolar lavage fluid(BALF)Galactomannan(GM)in patients with non-neutropenia and invasive pulmonary aspergillosis(IPA).Methods A retrospective analysis was conducted on 104 patients diagnosed and treated from April 2020 to April 2023,including 37 patients in the IPA group and 67 patients in the non-IPA group.The levels of BALF and serum GM in patients were measured and compared,and the correlation between serum and BALF GM detection was analyzed.The receiver operating characteristic(ROC)curve was used to determine the threshold value of BALF GM detection,and the diagnostic efficacy of the two tests was compared.Results The BALF and serum GM values in the IPA group were higher than those in the non-IPA group,and there was no significant difference in BALF and serum GM levels among patients with different underlying diseases.The critical value for BALF GM detection was 0.87,the sensitivity was 91.7%,the specificity was 92.5%,and the Youden index was 0.842.The positive rate of BALF GM in IPA patients is higher than that in serum GM(χ^(2)=42.659,P<0.001).Pearson analysis showed a weak positive correlation between BALF and serum GM in the IPA group(r=0.296,95%CI:0.170~0.412,P<0.001).The sensitivity and specificity of BALF GM were 91.7%and 92.5%,respectively;The sensitivity and specificity of serum GM were 16.7%and 98.5%,respectively;The sensitivity of double positivity was 8.3%,and the specificity was 99.3%;The sensitivity of either BALF or serum positivity was 99.6%,and the specificity was 91.8%.Conclusion The critical value of BALF GM detection is 0.87,and its diagnostic sensitivity for IPA is higher than that of serum GM detection.Different combinations can focus on improving the sensitivity or specificity of the detection.
作者
芦丹
刘旭
杨硕
LU Dan;LIU Xu;YANG Shuo(Department of Respiratory and Critical Care Medicine,Wuhan Integrated Traditional Chinese and Western Medicine Hospital(Wuhan First Hospital),Wuhan,Hubei 430022,China)
出处
《临床肺科杂志》
2023年第11期1621-1624,1634,共5页
Journal of Clinical Pulmonary Medicine
基金
武汉市卫健委科研项目资助(No.WX19C04)。
