University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
Biol Blood Marrow Transplant. 2011 Jul;17(7):1043-50. doi: 10.1016/j.bbmt.2010.11.013. Epub 2010 Nov 16.
Invasive pulmonary aspergillosis (IPA) is a major cause of mortality in patients with stem cell transplants and hematologic malignancies. Timely diagnosis of IPA improves survival but is difficult to make. We evaluated the effectiveness of bronchoalveolar lavage (BAL) galactomannan (GM) in diagnosing IPA in these populations by retrospectively reviewing records of 67 consecutive patients, in whom 89 BAL GM tests were performed. For patients with IPA, only the first BAL sample linked to the IPA episode was analyzed. Eighty samples were associated with proven, 12 with probable, and 32 with possible invasive fungal infections (IFI), and 37 were associated with no IFI. Among patients with IFIs, 4 had proven, 11 probable, and 32 possible IPA. Using BAL GM ≥ 0.5 (cutoff for serum GM) and ≥ 0.85 (optimal cutoff identified by receiver-operating characteristic curve), the sensitivity in diagnosing proven or probable IPA was 73% (11/15) and 67% (10/15), respectively, and specificity was 89% (33/37) and 95% (35/37). At these cutoffs, positive and negative predictive values were 73% (11/15) and 83% (10/12), and 89% (33/37) and 87% (35/40), respectively. BAL GM was more sensitive than cytology (0%, 0/14), BAL culture (27%, 4/15), transbronchial biopsy (40%, 2/5), or serum GM (67%, 10/15) for diagnosing IPA. BAL GM was ≥ 0.85 and ≥ 0.5 in 86% (6/7) and 100% (7/7) of patients with proven or probable IPA who received a mold-active agent for ≤ 3 days. BAL GM added sensitivity to serum GM and other means of diagnosing IPA, and was not impacted by short courses of mold-active agents.
侵袭性肺曲霉病（IPA）是干细胞移植和血液恶性肿瘤患者死亡的主要原因。IPA 的及时诊断可提高生存率，但诊断困难。我们通过回顾性分析 67 例连续患者的记录，评估了支气管肺泡灌洗（BAL）半乳甘露聚糖（GM）在这些人群中诊断 IPA 的有效性，其中 89 次 BAL GM 检测。对于 IPA 患者，仅分析与 IPA 发作相关的第一次 BAL 样本。80 个样本与确诊、12 个可能和 32 个可能的侵袭性真菌感染（IFI）相关，37 个与无 IFI 相关。在 IFI 患者中，有 4 例确诊，11 例可能，32 例可能 IPA。使用 BAL GM≥0.5（血清 GM 临界值）和≥0.85（ROC 曲线确定的最佳临界值），诊断确诊或可能 IPA 的敏感性分别为 73%（11/15）和 67%（10/15），特异性分别为 89%（33/37）和 95%（35/37）。在这些临界值下，阳性和阴性预测值分别为 73%（11/15）和 83%（10/12），89%（33/37）和 87%（35/40）。BAL GM 比细胞学（0%，0/14）、BAL 培养（27%，4/15）、经支气管活检（40%，2/5）或血清 GM（67%，10/15）更敏感，用于诊断 IPA。在接受≤3 天 mold-active 药物治疗的确诊或可能 IPA 患者中，BAL GM 分别有 86%（6/7）和 100%（7/7）的患者 GM 水平≥0.85 和≥0.5。BAL GM 增加了血清 GM 和其他 IPA 诊断方法的敏感性，并且不受短疗程 mold-active 药物的影响。
