1 Clinic of Pulmonary Medicine and Respiratory Cell Research.
Am J Respir Crit Care Med. 2014 Aug 1;190(3):309-17. doi: 10.1164/rccm.201403-0431OC.
Invasive fungal disease (IFD) is a significant cause of morbidity and mortality in immunocompromised patients.
We hypothesize that galactomannan (GM), a component of fungal cell wall, as measured in bronchoalveolar lavage (BAL) might be a diagnostic adjunct in hematologic malignancies.
A total of 568 hematologic cases undergoing diagnostic bronchoscopy because of respiratory symptoms and/or suspected IFD between 2009 and 2013 at a tertiary care center in Switzerland were included in this prospective, observational cohort study. We compared accuracy of the BAL GM ELISA determination in predicting IFD as classified by the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group (EORTC/MSG) definition.
BAL GM was positive in 155 cases (29.2%). According to the EORTC/MSG criteria, IFD was classified as possible in 182 (34.3%), probable in 45 (8.5%), and proved in six (1.1%). BAL GM provided 50% sensitivity, 73.0% specificity, 16% positive predictive value, and 93% negative predictive value for diagnosing proven+probable IFD. Results were similar when antifungal treatment and radiologic suspicion of IFD were used as the gold standard. The area under the curve of the receiver operating characteristic curve for the diagnosis of proven+probable IFD was 0.716 (95% confidence interval, 0.638-0.794; P < 0.001).
GM in BAL had modest agreement with EORTC/MSG criteria for diagnosing IFD in immunocompromised patients with a high degree of antifungal exposure.
侵袭性真菌病（IFD）是免疫功能低下患者发病率和死亡率的重要原因。
我们假设真菌细胞壁的成分半乳甘露聚糖（GM）在支气管肺泡灌洗液（BAL）中的测量可能是血液恶性肿瘤的诊断辅助手段。
在瑞士的一家三级护理中心，我们对 2009 年至 2013 年间因呼吸系统症状和/或疑似 IFD 而行诊断性支气管镜检查的 568 例血液病例进行了这项前瞻性观察队列研究。我们比较了 BAL GM ELISA 测定在预测 IFD 方面的准确性，该测定是根据欧洲癌症研究与治疗组织/侵袭性真菌感染合作组（EORTC/MSG）的定义进行分类的。
BAL GM 在 155 例病例中呈阳性（29.2%）。根据 EORTC/MSG 标准，IFD 被分类为可能的 182 例（34.3%）、可能的 45 例（8.5%）和证实的 6 例（1.1%）。BAL GM 对诊断确诊+可能 IFD 的敏感性为 50%，特异性为 73.0%，阳性预测值为 16%，阴性预测值为 93%。当使用抗真菌治疗和 IFD 的放射学怀疑作为金标准时，结果相似。诊断确诊+可能 IFD 的受试者工作特征曲线下面积为 0.716（95%置信区间，0.638-0.794；P <0.001）。
GM 在 BAL 中的存在与 EORTC/MSG 标准在诊断免疫功能低下且具有高度抗真菌暴露的患者的 IFD 方面具有中等一致性。
