Department of Internal Medicine - Hematology and Oncology, Masaryk University and University Hospital Brno, Jihlavska 20, 625 00 Brno, Czech Republic.
Int J Infect Dis. 2011 Dec;15(12):e874-81. doi: 10.1016/j.ijid.2011.09.011. Epub 2011 Oct 30.
We evaluated the performance of a galactomannan (GM) assay in bronchoalveolar lavage (BAL) fluid compared to serum samples for the diagnosis of invasive pulmonary aspergillosis (IPA) in patients with hematological diseases.
Two hundred and fifty-five bronchoscopies were performed on 230 patients. Bronchial and alveolar samples from BAL fluid as well as serum samples were analyzed in the GM assay.
Twenty-eight cases of IPA (11%) were diagnosed. The sensitivity, specificity, positive predictive value, and negative predictive value of the GM assay using a cut-off of 0.5 were 57.1%, 99.3%, 94.1%, and 92.5%, respectively, for the alveolar sample; 44.0%, 99.3%, 91.7%, and 91.4%, respectively, for the bronchial sample; and 60.7%, 100%, 100%, and 92.9%, respectively, for serum. The highest sensitivity (78.6%) with good specificity (98.6%) was obtained with a 'triple detection' of GM in bronchial, alveolar, and serum samples. Neutropenia and antifungal therapy for only 24h increased the sensitivity, while antifungal treatment for ≥ 2 days decreased assay performance. Moreover, a trend towards a higher volume of aspirated fluid in GM-negative BAL (p=0.092) was observed.
In contrast to recently published data, we found only moderate sensitivity, but high specificity and high positive predictive value of the detection of GM in BAL fluid. In addition, neutropenia, antifungal therapy, and BAL standardization affected GM assay performance.
我们评估了半乳甘露聚糖（GM）检测在支气管肺泡灌洗液（BAL）与血清样本中的性能，以用于诊断血液系统疾病患者的侵袭性肺曲霉病（IPA）。
对 230 名患者进行了 255 次支气管镜检查。分析了支气管肺泡灌洗液（BAL）和血清样本中的 GM 检测。
诊断出 28 例 IPA（11%）。GM 检测的肺泡样本的截止值为 0.5 时，灵敏度、特异性、阳性预测值和阴性预测值分别为 57.1%、99.3%、94.1%和 92.5%；支气管样本分别为 44.0%、99.3%、91.7%和 91.4%；血清样本分别为 60.7%、100%、100%和 92.9%。支气管、肺泡和血清样本 GM 的“三重检测”获得了最高的灵敏度（78.6%）和良好的特异性（98.6%）。中性粒细胞减少症和仅 24 小时的抗真菌治疗增加了检测的灵敏度，而≥2 天的抗真菌治疗则降低了检测的性能。此外，GM 阴性 BAL 中抽吸液体积较大的趋势（p=0.092）。
与最近发表的数据相比，我们发现 GM 在 BAL 中的检测灵敏度仅为中等，但特异性和阳性预测值较高。此外，中性粒细胞减少症、抗真菌治疗和 BAL 标准化会影响 GM 检测的性能。
