Zhou Wei, Li Hongxing, Zhang Yan, Huang Mei, He Qian, Li Pei, Zhang Fang, Shi Yi, Su Xin
Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southern Medical University, Guangzhou, China.
J Clin Microbiol. 2017 Jul;55(7):2153-2161. doi: 10.1128/JCM.00345-17. Epub 2017 Apr 26.
The objective of this study was to compare the diagnostic value of galactomannan (GM) detection in bronchoalveolar lavage fluid (BALF) and serum samples from nonneutropenic patients with invasive pulmonary aspergillosis (IPA) and determine the optimal BALF GM cutoff value for pulmonary aspergillosis. GM detection in BALF and serum samples was performed by enzyme-linked immunosorbent assay (ELISA) in 128 patients with clinically suspected nonneutropenic pulmonary aspergillosis between June 2014 and June 2016. On the basis of the clinical and pathological diagnoses, 8 patients were excluded because their diagnosis was uncertain. The remaining 120 patients were diagnosed with either IPA ( = 37), community-acquired pneumonia (CAP; = 59), noninfectious diseases ( = 19), or tuberculosis ( = 5). At a cutoff optical density index (ODI) value of ≥0.5, the sensitivity of BALF GM detection was much higher than that of serum GM detection (75.68% versus 37.84%; = 0.001), but there was no significant difference between their specificities (80.72% versus 87.14%; = 0.286). At a cutoff value of ≥1.0, the sensitivity of BALF GM detection was still much higher than that of serum GM detection (64.86% versus 24.32%; < 0.001), and their specificities were similar (90.36% versus 95.71%; = 0.202). Receiver operating characteristic (ROC) curve analysis showed that when the BALF GM detection cutoff value was 0.7, its diagnostic value for pulmonary aspergillosis was optimized, and the sensitivity and specificity reached 72.97% and 89.16%, respectively. BALF GM detection was valuable for the diagnosis of IPA in nonneutropenic patients, and its diagnostic value was superior to that of serum GM detection. The optimal BALF GM cutoff value was 0.7.
本研究的目的是比较支气管肺泡灌洗液（BALF）和血清样本中半乳甘露聚糖（GM）检测对非中性粒细胞减少的侵袭性肺曲霉病（IPA）患者的诊断价值，并确定肺曲霉病的最佳BALF GM临界值。在2014年6月至2016年6月期间，采用酶联免疫吸附测定（ELISA）对128例临床怀疑为非中性粒细胞减少性肺曲霉病的患者的BALF和血清样本进行GM检测。根据临床和病理诊断，排除8例诊断不明确的患者。其余120例患者被诊断为IPA（n = 37）、社区获得性肺炎（CAP；n = 59）、非感染性疾病（n = 19）或结核病（n = 5）。在临界光密度指数（ODI）值≥0.5时，BALF GM检测的敏感性远高于血清GM检测（75.68%对37.84%；P = 0.001），但其特异性之间无显著差异（80.72%对87.14%；P = 0.286）。在临界值≥1.0时，BALF GM检测的敏感性仍远高于血清GM检测（64.86%对24.32%；P < 0.001），且它们的特异性相似（90.36%对95.71%；P = 0.202）。受试者操作特征（ROC）曲线分析表明，当BALF GM检测临界值为0.7时，其对肺曲霉病的诊断价值最佳，敏感性和特异性分别达到72.97%和89.16%。BALF GM检测对非中性粒细胞减少患者的IPA诊断有价值，其诊断价值优于血清GM检测。最佳BALF GM临界值为0.7。
