Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
J Heart Lung Transplant. 2017 Sep;36(9):973-979. doi: 10.1016/j.healun.2017.04.007. Epub 2017 Apr 19.
Invasive aspergillosis is the most common invasive fungal infection in lung transplant recipients. The use of galactomannan testing in bronchoalveolar lavage (BAL) fluid has improved diagnosis of invasive aspergillosis; however, false-positive results can lead to overdiagnosis and unnecessary treatment. The use of proinflammatory markers such as pentraxin 3 (PTX3) may help differentiate between Aspergillus colonization and disease.
BAL PTX3 concentrations were measured by enzyme-linked immunosorbent assay in 151 lung transplant recipients and 9 healthy control subjects. Patients were characterized as having Aspergillus colonization or invasive disease according to International Society of Heart and Lung Transplantation criteria. Concomitant PTX3values were compared using Mann-Whitney U and Kruskal-Wallis tests.
We analyzed 322 BAL stored samples and identified 15 invasive aspergillosis events, 38 Aspergillus colonizations, and 17 positive galactomannan with negative Aspergillus cultures. Median BAL PTX3 level was significantly higher in patients with invasive aspergillosis compared with patients with Aspergillus colonization and healthy control subjects (439.20 pg/ml [interquartile range (IQR) 168.18-778.90], 68.93 pg/ml [IQR 13.67-156.74], and 13.67 pg/ml [IQR 13.67-121.18]; p < 0.001). Patients with BAL PTX3 value >319 pg/ml with positive galactomannan and patients with BAL PTX3 value >312 pg/ml with positive Aspergillus culture were 4.5 and 5.5 times more likely to have invasive pulmonary aspergillosis, respectively.
Our study shows that PTX3 measurements in BAL samples were significantly higher among patients with invasive aspergillosis and may help to identify patients with Aspergillus colonization and false-positive galactomannan in BAL samples.
侵袭性曲霉菌病是肺移植受者中最常见的侵袭性真菌感染。支气管肺泡灌洗液（BAL）中半乳甘露聚糖检测的应用提高了侵袭性曲霉菌病的诊断；然而，假阳性结果可能导致过度诊断和不必要的治疗。使用促炎标志物，如五聚素 3（PTX3），可能有助于区分曲霉菌定植和疾病。
通过酶联免疫吸附试验测量 151 例肺移植受者和 9 例健康对照者的 BAL PTX3 浓度。根据国际心肺移植协会的标准，将患者特征为曲霉菌定植或侵袭性疾病。使用 Mann-Whitney U 和 Kruskal-Wallis 检验比较同时的 PTX3 值。
我们分析了 322 个 BAL 储存样本，确定了 15 例侵袭性曲霉菌病事件、38 例曲霉菌定植和 17 例阳性半乳甘露聚糖和阴性曲霉菌培养物。与曲霉菌定植和健康对照组相比，侵袭性曲霉菌病患者的 BAL PTX3 水平明显更高（中位数 439.20 pg/ml [四分位距（IQR）168.18-778.90]、68.93 pg/ml [IQR 13.67-156.74] 和 13.67 pg/ml [IQR 13.67-121.18]；p<0.001）。BAL PTX3 值>319 pg/ml 伴阳性半乳甘露聚糖和 BAL PTX3 值>312 pg/ml 伴阳性曲霉菌培养的患者发生侵袭性肺曲霉菌病的可能性分别增加 4.5 倍和 5.5 倍。
我们的研究表明，BAL 样本中 PTX3 的测量值在侵袭性曲霉菌病患者中明显升高，可能有助于识别曲霉菌定植和 BAL 样本中假阳性半乳甘露聚糖的患者。
