Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; 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, Medical School of Nanjing University, Nanjing, China.
Clin Microbiol Infect. 2023 Jun;29(6):797.e1-797.e7. doi: 10.1016/j.cmi.2023.02.002. Epub 2023 Feb 10.
Aspergillus-specific IgG antibody (Asp IgG) has been successfully applied in the diagnosis of chronic pulmonary aspergillosis. We explored its value in nonneutropenic invasive pulmonary aspergillosis (IPA) by a multicenter, prospective, and controlled study.
We enrolled 372 clinically suspected nonneutropenic patients with IPA from February 2015 to August 2022. After excluding 4 cases with Aspergillus colonization, the remaining 368 cases were finally confirmed as patients with IPA (n = 99), or non-IPA patients (n = 269) consisting of community-acquired pneumonia (n = 206), tuberculosis (n = 22), nontuberculous mycobacteria (n = 5), lung abscess (n = 6), or noninfectious diseases (n = 30). Asp IgG in plasma samples was tested by enzyme-linked immunosorbent assay.
At cut-off value of ≥80 AU/mL, Asp IgG had much higher sensitivity (59.6% vs. 19.2%, p < 0.0001), but lower specificity (77.0% vs. 96.3%, p < 0.0001) than serum galactomannan (GM) (cut-off value of ≥1.0), and similar sensitivity (59.6% vs. 55.6%, p = 0.611) but lower specificity (77.0% vs. 91.2%, p = 0.001) than bronchoalveolar lavage fluid (BALF) GM (cut-off value of ≥1.0), respectively. Combination diagnosis of either positive for Asp IgG or BALF GM had higher sensitivity (81.0% vs. 55.6%, p = 0.002), but lower specificity (75.2% vs. 91.2%, p = 0.001) than BALF GM alone. The receiver operating characteristic curve showed that Asp IgG had an optimal diagnostic value when the cut-off value was 56.6 AU/ml, and the sensitivity and specificity were 77.8% and 63.9%, respectively.
The diagnostic value of Asp IgG for IPA is superior to serum GM, and a little inferior to BALF GM in nonneutropenic patients with IPA. Considering the convenience of taking blood samples, it is a good screening and diagnostic method for nonneutropenic patients with IPA, especially for those who cannot bear invasive procedures.
曲霉特异性 IgG 抗体（Asp IgG）已成功应用于慢性肺曲霉病的诊断。我们通过多中心、前瞻性、对照研究探讨了其在非中性粒细胞性侵袭性肺曲霉病（IPA）中的价值。
我们纳入了 2015 年 2 月至 2022 年 8 月期间 372 例临床疑似非中性粒细胞性 IPA 患者。排除 4 例曲霉定植后，最终确定 368 例患者为 IPA（n=99）或非 IPA 患者（n=269），包括社区获得性肺炎（n=206）、肺结核（n=22）、非结核分枝杆菌（n=5）、肺脓肿（n=6）或非传染性疾病（n=30）。采用酶联免疫吸附试验检测血浆样本中的 Asp IgG。
在≥80 AU/ml 截断值时，Asp IgG 的敏感性（59.6%比 19.2%，p<0.0001）高于血清半乳甘露聚糖（GM）（≥1.0），但特异性（77.0%比 96.3%，p<0.0001）较低；与支气管肺泡灌洗液（BALF）GM（≥1.0）相比，敏感性（59.6%比 55.6%，p=0.611）相似，特异性（77.0%比 91.2%，p=0.001）较低。Asp IgG 或 BALF GM 联合诊断的敏感性（81.0%比 55.6%，p=0.002）较高，特异性（75.2%比 91.2%，p=0.001）较低。受试者工作特征曲线显示，当截断值为 56.6 AU/ml 时，Asp IgG 的诊断价值最佳，敏感性和特异性分别为 77.8%和 63.9%。
在非中性粒细胞性 IPA 患者中，Asp IgG 对 IPA 的诊断价值优于血清 GM，稍低于 BALF GM。考虑到采血的便利性，它是一种很好的非中性粒细胞性 IPA 患者的筛查和诊断方法，尤其是对那些不能耐受侵袭性操作的患者。
