Yan Q F, Sun Z L, Gao Y, Xiao T, Lin H, Ji M
Department of Respiratory Medicine, Ninghai First Hospital, Ningbo 315600, China.
Department of Clinical Laboratory, Ninghai First Hospital, Ningbo 315600, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2021 Aug 12;44(8):711-716. doi: 10.3760/cma.j.cn112147-20201123-01113.
To evaluate the diagnostic value of bronchoalveolar lavage fluid pathogen detection combined with cryptococcal antigen test(CrAg) for pulmonary cryptococcosis(PC). A retrospective case analysis was performed on non-acquired immunodeficiency syndrome patients admitted to Ninghai First Hospital for suspected PC from January 2018 to December 2019. Fifty-nine patients were included. Sixteen cases (8 males and 8 females) were diagnosed with PC, aged from 18 to 76 years[an average age of (52±14) years], while 43 cases were diagnosed as having Non-PC. All patients had undergone both serum CrAg test and BALF pathogen detection(cultures and direct examination) combined with BALF-CrAg test. The sensitivity and specificity of the combined method of BALF was evaluated, and a parallel comparison of the diagnostic efficiencies of the two methods were made. Of the 16 confirmed PC cases, serum CrAg tests were positive in 11 and negative in 5 cases, while the combined method showed that 14 were positive and 2 were negative. Compared with the clinical final diagnosis, the sensitivity, specificity, positive predictive value and negative predictive value showed that the serum CrAg tests were 68.8% (11/16), 97.7% (42/43), 91.7% (11/12), 89.3% (42/47) respectively, versus 87.5% (14/16), 100.0% (43/43), 100% (14/14), 95.6% (43/45) by the combined method of BALF. The results displayed no statistical difference between the two diagnostic methods ( =1.000). Among the 5 initially serum CrAg-negative cases, 4 were later confirmed as proven PC via the combined method of BALF and the other one by percutaneous lung biopsy. The combined method of BALF pathogen detection with BALF-CrAg showed a similar statistical efficiency rate for diagnosing pulmonary cryptococcosis compared with serum CrAg tests. It may serve as an efficient diagnosis method for PC cases with negative serum CrAg tests.
评估支气管肺泡灌洗液体病原体检测联合隐球菌抗原检测（CrAg）对肺隐球菌病（PC）的诊断价值。对2018年1月至2019年12月因疑似PC入住宁海第一医院的非获得性免疫缺陷综合征患者进行回顾性病例分析。纳入59例患者。16例（男8例，女8例）被诊断为PC，年龄18至76岁[平均年龄（52±14）岁]，43例被诊断为非PC。所有患者均接受了血清CrAg检测、BALF病原体检测（培养和直接检查）以及BALF-CrAg检测。评估BALF联合检测方法的敏感性和特异性，并对两种方法的诊断效率进行平行比较。在16例确诊的PC病例中，血清CrAg检测11例阳性，5例阴性，而联合检测方法显示14例阳性，2例阴性。与临床最终诊断相比，血清CrAg检测的敏感性、特异性、阳性预测值和阴性预测值分别为68.8%（11/16）、97.7%（42/43）、91.7%（11/12）、89.3%（42/47），而BALF联合检测方法分别为87.5%（14/16）、100.0%（43/43）、100%（14/14）、95.6%（43/45）。两种诊断方法之间的结果无统计学差异（ =1.000）。在最初血清CrAg阴性的5例病例中，4例后来通过BALF联合检测方法确诊为PC，另1例通过经皮肺活检确诊。BALF病原体检测与BALF-CrAg联合检测方法在诊断肺隐球菌病方面与血清CrAg检测具有相似的统计效率。它可能是血清CrAg检测阴性的PC病例的一种有效诊断方法。
