Dai Zhang, Cai Minjing, Yao Yihui, Zhu Jianhui, Lin Lingqing, Fang Lili, Li Zhimeng, Yi Huochun, Chen Bo, Liang Xianming
Center of Clinical Laboratory, Zhongshan Hospital.
Institute of Infectious Disease.
Medicine (Baltimore). 2021 Apr 9;100(14):e25233. doi: 10.1097/MD.0000000000025233.
The incidence of invasive pulmonary aspergillosis (IPA) is increasing higher in non-neutropenic patients. This study aimed to assess the diagnostic performance of bronchoalveolar lavage fluid (BALF). Galactomannan (GM), serum GM, and 1,3-β-d-glucan (BDG) in non-neutropenic respiratory disease patients with IPA.A total of 333 non-neutropenic patients suspected IPA were recruited from Xiamen University Zhong Shan hospital between January 2016 and February 2019. One, 33, and 92 cases were diagnosed with proven, and possible IPA.BALF and serum GM were both elevated in the possible IPA group and the probable/proven IPA group (p < 0.001). BALF and serum GM showed a fair correlation in the possible IPA group (r = 0.286, p = 0.008), and moderate correlation in the probable/proven IPA group (r = 0.466, p = 0.005). When the cutoff value was 0.5, the sensitivity and negative likelihood ratio of BALF GM were superior to serum GM (78.3% vs 47.8%, 96.7% vs 91.6%). The specificity and positive likelihood ratio of BALF GM were slightly weaker than serum GM (91.8% vs 95.4%, 56.7% vs 85.0%). When the cutoff value was 1.0, the sensitivity and negative predictive value of BALF GM were better than serum GM (73.9% vs 26.1%, 94.5% vs 88.8%), and the specificity of were equivalent (99.2%). The optimal cutoff value of BALF GM was 0.6, wherein the sensitivity reached 78.3% and the specificity reached 95.4%. Given the extremely low sensitivity of serum BDG at different cutoff values (≥10 μg/mL = 5.3%, ≥20 μg/mL = 2.1%), it cannot be used as a preferred biomarker.The diagnostic performance of BALF GM was superior to other biomarkers and the optimal cutoff value was 0.6.
侵袭性肺曲霉病（IPA）在非中性粒细胞减少患者中的发病率正日益升高。本研究旨在评估支气管肺泡灌洗术（BALF）、半乳甘露聚糖（GM）、血清GM以及1,3-β-D-葡聚糖（BDG）在非中性粒细胞减少的IPA呼吸道疾病患者中的诊断效能。2016年1月至2019年2月期间，从厦门大学附属中山医院招募了333例疑似IPA的非中性粒细胞减少患者。其中，1例、33例和92例分别被诊断为确诊、可能的IPA。在可能的IPA组和很可能/确诊的IPA组中，BALF和血清GM均升高（p<0.001）。在可能的IPA组中，BALF和血清GM呈中等程度相关（r=0.286，p=0.008），在很可能/确诊的IPA组中呈中度相关（r=0.466，p=0.005）。当临界值为0.5时，BALF GM的敏感性和阴性似然比优于血清GM（78.3%对47.8%，96.7%对91.6%）。BALF GM的特异性和阳性似然比略弱于血清GM（91.8%对95.4%，56.7%对85.0%）。当临界值为1.0时，BALF GM的敏感性和阴性预测值优于血清GM（73.9%对26.1%，94.5%对88.8%），特异性相当（99.2%）。BALF GM的最佳临界值为0.6，此时敏感性达到78.3%，特异性达到95.4%。鉴于血清BDG在不同临界值下的敏感性极低（≥10μg/mL=5.3%，≥20μg/mL=2.1%），故不能将其用作首选生物标志物。BALF GM的诊断效能优于其他生物标志物，最佳临界值为0.6。
