支气管肺泡灌洗液半乳甘露聚糖检测对侵袭性曲霉病的诊断准确性。
Diagnostic Accuracy of Bronchoalveolar Lavage Fluid Galactomannan for Invasive Aspergillosis.
机构信息
Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China.
Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou 511436, China.
出版信息
Biomed Res Int. 2020 Nov 30;2020:5434589. doi: 10.1155/2020/5434589. eCollection 2020.
BACKGROUND
The pathogenesis of invasive aspergillosis (IA) is still unknown, but its progression is rapid and mortality rate remains high. Bronchoalveolar lavage fluid (BALF) galactomannan (GM) analysis has been used to diagnose IA. This study is aimed at making an accurate estimate of the whole accuracy of BALF-GM in diagnosing IA.
METHODS
After a systematic review of the study, a bivariate meta-analysis was used to summarize the specificity (SPE), the sensitivity (SEN), the positive likelihood ratios (PLR), and the negative likelihood ratios (NLR) of BALF-GM in diagnosing IA. The overall test performance was summarized using a layered summary receiver operating characteristic (SROC) curve. Subgroup analysis was performed to explore the heterogeneity between studies.
RESULTS
A total of 65 studies that are in line with the inclusion criteria were included. The summary estimates of BALF-GM analysis are divided into four categories. The first is the proven+probable vs. possible+no IA, with an SPE, 0.87 (95% CI, 0.85-0.98); SEN, 0.81 (95% CI, 0.76-0.84); PLR, 9.78 (5.78-16.56); and NLR, 0.20 (0.14-0.29). The AUC was 0.94. The BALF-GM test for proven+probable vs. no IA showed SPE, 0.88 (95% CI, 0.87-0.90); SEN, 0.82 (95% CI, 0.78-0.85); PLR, 6.56 (4.93-8.75); and NLR, 0.24 (0.17-0.33). The AUC was 0.93. The BALF-GM test for proven+probable+possible vs. no IA showed SPE, 0.82 (95% CI, 0.79-0.95); SEN, 0.59 (95% CI, 0.55-0.63); PLR, 3.60 (2.07-6.25); and NLR, 0.31 (0.15-0.61). The AUC was 0.86. The analyses for others showed SPE, 0.85 (95% CI, 0.83-0.87); SEN, 0.89 (95% CI, 0.86-0.91); PLR, 6.91 (4.67-10.22); and NLR, 0.18 (0.13-0.26). The AUC was 0.94.
CONCLUSIONS
The findings of this BALF-GM test resulted in some impact on the diagnosis of IA. The BALF-GM assay is considered a method for diagnosing IA with high SEN and SPE. However, the patients' underlying diseases may affect the accuracy of diagnosis. When the cutoff is greater than 1, the sensitivity will be higher.
背景
侵袭性曲霉病（IA）的发病机制尚不清楚，但病情进展迅速，死亡率仍然很高。支气管肺泡灌洗液（BALF）半乳甘露聚糖（GM）分析已被用于诊断 IA。本研究旨在对 BALF-GM 诊断 IA 的整体准确性进行准确估计。
方法
在对研究进行系统回顾后，使用双变量荟萃分析总结 BALF-GM 诊断 IA 的特异性（SPE）、敏感性（SEN）、阳性似然比（PLR）和阴性似然比（NLR）。使用分层汇总受试者工作特征（SROC）曲线总结总体测试性能。进行亚组分析以探索研究之间的异质性。
结果
共有 65 项符合纳入标准的研究被纳入。BALF-GM 分析的汇总估计值分为四类。第一类是确诊+可能与可能+无 IA，SPE 为 0.87（95%CI，0.85-0.98）；SEN，0.81（95%CI，0.76-0.84）；PLR，9.78（5.78-16.56）；NLR，0.20（0.14-0.29）。AUC 为 0.94。BALF-GM 检测确诊+可能与无 IA 比较，SPE 为 0.88（95%CI，0.87-0.90）；SEN，0.82（95%CI，0.78-0.85）；PLR，6.56（4.93-8.75）；NLR，0.24（0.17-0.33）。AUC 为 0.93。BALF-GM 检测确诊+可能+可能与无 IA 比较，SPE 为 0.82（95%CI，0.79-0.95）；SEN，0.59（95%CI，0.55-0.63）；PLR，3.60（2.07-6.25）；NLR，0.31（0.15-0.61）。AUC 为 0.86。其他分析显示 SPE 为 0.85（95%CI，0.83-0.87）；SEN，0.89（95%CI，0.86-0.91）；PLR，6.91（4.67-10.22）；NLR，0.18（0.13-0.26）。AUC 为 0.94。
结论
本 BALF-GM 检测结果对 IA 的诊断有一定影响。BALF-GM 检测被认为是一种具有高 SEN 和 SPE 的 IA 诊断方法。然而，患者的基础疾病可能会影响诊断的准确性。当截点值大于 1 时，灵敏度会更高。
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