Kim Eun-Young, Yong Seung-Hyun, Sung Min-Dong, Woo A-La, Park Young-Mok, Kim Ha-Eun, Jung Su-Jin, Kim Song-Yee, Lee Jin-Gu, Kim Young-Sam, Paik Hyo-Chae, Park Moo-Suk
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
J Fungi (Basel). 2023 Apr 28;9(5):527. doi: 10.3390/jof9050527.
Invasive pulmonary aspergillosis (IPA) can occur in immunocompromised patients, and an early detection and intensive treatment are crucial. We sought to determine the potential of Aspergillus galactomannan antigen titer (AGT) in serum and bronchoalveolar lavage fluid (BALF) and serum titers of beta-D-glucan (BDG) to predict IPA in lung transplantation recipients, as opposed to pneumonia unrelated to IPA. We retrospectively reviewed the medical records of 192 lung transplant recipients. Overall, 26 recipients had been diagnosed with proven IPA, 40 recipients with probable IPA, and 75 recipients with pneumonia unrelated to IPA. We analyzed AGT levels in IPA and non-IPA pneumonia patients and used ROC curves to determine the diagnostic cutoff value. The Serum AGT cutoff value was 0.560 (index level), with a sensitivity of 50%, specificity of 91%, and AUC of 0.724, and the BALF AGT cutoff value was 0.600, with a sensitivity of 85%, specificity of 85%, and AUC of 0.895. Revised EORTC suggests a diagnostic cutoff value of 1.0 in both serum and BALF AGT when IPA is highly suspicious. In our group, serum AGT of 1.0 showed a sensitivity of 27% and a specificity of 97%, and BALF AGT of 1.0 showed a sensitivity of 60% and a specificity of 95%. The result suggested that a lower cutoff could be beneficial in the lung transplant group. In multivariable analysis, serum and BALF AGT, with a minimal correlation between the two, showed a correlation with a history of diabetes mellitus.
侵袭性肺曲霉病（IPA）可发生于免疫功能低下的患者，早期检测和强化治疗至关重要。我们试图确定血清和支气管肺泡灌洗液（BALF）中的曲霉半乳甘露聚糖抗原滴度（AGT）以及β - D - 葡聚糖（BDG）的血清滴度对肺移植受者中IPA的预测潜力，以区别于与IPA无关的肺炎。我们回顾性分析了192例肺移植受者的病历。总体而言，26例受者被诊断为确诊IPA，40例受者为可能的IPA，75例受者为与IPA无关的肺炎。我们分析了IPA患者和非IPA肺炎患者的AGT水平，并使用ROC曲线确定诊断临界值。血清AGT临界值为0.560（指数水平），敏感性为50%，特异性为91%，曲线下面积（AUC）为0.724；BALF AGT临界值为0.600，敏感性为85%，特异性为85%，AUC为0.895。修订后的欧洲癌症研究与治疗组织（EORTC）建议，当IPA高度可疑时，血清和BALF AGT的诊断临界值均为1.0。在我们的研究组中，血清AGT为1.0时敏感性为27%，特异性为97%；BALF AGT为1.0时敏感性为60%，特异性为95%。结果表明较低的临界值对肺移植组可能有益。在多变量分析中，血清和BALF AGT两者之间相关性极小，但均与糖尿病病史相关。
