Department of Respiratory Diseases, Nursing School, Guangxi Medical University, Nanning, Guangxi, ROC.
Chest. 2010 Oct;138(4):817-24. doi: 10.1378/chest.10-0488. Epub 2010 May 7.
A serum galactomannan (GM) assay has been approved for diagnosing invasive aspergillosis (IA). However, the role of the BAL-GM assay has not been well established. Therefore, we conducted a metaanalysis to determine the overall accuracy of BAL-GM in the diagnosis of IA.
After a systematic review of English-language studies, the sensitivity (SEN), specificity (SPE), and positive and negative likelihood ratios (PLR and NLR, respectively) of BAL-GM for the diagnosis of IA were pooled using a bivariate metaanalysis. Hierarchic summary receiver operating characteristic curves were used to summarize overall test performance. Potential between-study heterogeneity was explored by subgroup analyses. We calculated posttest probability to evaluate clinical usefulness.
Twelve reports, including 13 studies, met our inclusion criteria. The summary estimates of the BAL-GM assay for proven or probable IA were as follows: SEN, 0.90 (95% CI, 0.79-0.96); SPE, 0.94 (95% CI, 0.90-0.96); PLR, 14.87 (95% CI, 8.89-24.90); and NLR, 0.10 (95% CI, 0.04-0.24). The four summary estimates of the BAL-GM assay for proven IA were 0.94 (95% CI, 0.86-0.98), 0.79 (95% CI, 0.68-0.86), 4.41 (95% CI, 2.87-6.77), and 0.07 (95% CI, 0.03-0.09), respectively. Significant heterogeneity was present.
BAL-GM determination is a sensitive and specific test for the diagnosis of proven and probable IA. The measurement of BAL-GM is thus likely to be a useful tool for diagnosing IA. Further studies focused on the impact of treatment agents are needed.
血清半乳甘露聚糖（GM）检测已被批准用于诊断侵袭性曲霉病（IA）。然而，支气管肺泡灌洗液 GM 检测在诊断中的作用尚未得到充分确立。因此，我们进行了一项荟萃分析，以确定 BAL-GM 检测在诊断 IA 中的总体准确性。
在对英文文献进行系统评价后，使用双变量荟萃分析汇总 BAL-GM 检测对 IA 诊断的敏感性（SEN）、特异性（SPE）以及阳性和阴性似然比（PLR 和 NLR）。使用层次汇总受试者工作特征曲线总结总体检测性能。通过亚组分析探索潜在的研究间异质性。我们计算了 posttest probability 以评估临床实用性。
12 份报告，包含 13 项研究，符合我们的纳入标准。BAL-GM 检测对确诊或拟诊 IA 的汇总估计值如下：SEN，0.90（95%置信区间，0.79-0.96）；SPE，0.94（95%置信区间，0.90-0.96）；PLR，14.87（95%置信区间，8.89-24.90）；NLR，0.10（95%置信区间，0.04-0.24）。BAL-GM 检测对确诊 IA 的四项汇总估计值分别为 0.94（95%置信区间，0.86-0.98）、0.79（95%置信区间，0.68-0.86）、4.41（95%置信区间，2.87-6.77）和 0.07（95%置信区间，0.03-0.09）。存在显著的异质性。
BAL-GM 检测是诊断确诊和拟诊 IA 的一种敏感和特异的检测方法。因此，BAL-GM 检测可能是诊断 IA 的有用工具。需要进一步研究关注治疗药物的影响。
