摘要目的 探讨血清及BALF半乳甘露聚糖试验(GM试验)对非粒细胞缺乏患者侵袭性肺曲霉病(IPA)的诊断价值.方法 前瞻性收集2014年9月至2015年10月,温州医科大学附属第一医院呼吸与危重症医学科因咳嗽、呼吸困难和(或)发热等住院的1356例病例的临床资料,男879例,女477例,年龄18~96岁,平均(64±15)岁.排除慢性肺曲霉病及粒细胞缺乏病例.根据中国肺真菌病诊治专家共识分为IPA组与非IPA组.IPA组39例,年龄38~94岁,平均(68±12)岁;非IPA组1317例,为不符合IPA组的其他住院患者,年龄18~96岁,平均(64±15)岁.收集入选病例的临床资料、血清和BALF的GM试验结果,用SPSS20.0软件对数据进行统计分析.本研究为前瞻性病例对照研究.结果 1356例行血清GM试验,96例同时行血清和BALF GM试验.诊断为IPA 39例,确诊7例,临床诊断32例.血清GM试验对非粒细胞缺乏患者并发IPA诊断的敏感度、特异度、阳性预测值(PPV)及阴性预测值(NPV)分别为43.6%(17/39)、94.1%(1239/1317)、17.9%(17/95)和98.3%(1239/1261),受试者工作特征(ROC)曲线下面积为0.79.96例同时行BALF的GM试验,其临界值为0.8μg/L时的敏感度、特异度、PPV及NPV分别为86.7%(13/15)、60.5%(49/81)、28.9%(13/45)和96.1%(49/51);临界值为1.0μg/L时为86.7%(13/15)、74.1%(60/81)、38.2%(13/34)和96.8%(60/62).BALF和血清GM试验及两者联合应用时的ROC曲线下面积分别为0.87、0.75和0.90.结论 血清GM试验对非粒细胞缺乏患者并发IPA诊断的敏感度低,但阴性预测值较高;BALF GM试验临界值为1.0μg/L时的诊断效能最高;同时进行BALF和血清GM试验可提高诊断效能.

abstractsObjective To evaluate the diagnostic performance of galactomannan ( GM) detection in serum and BALF for invasive pulmonary aspergillosis ( IPA) in non-neutropenic hosts.Methods A pospective study was performed for 1356 non-neutropenic hosts admitted to the Department of Pulmonary and Critical Care Medicine of the First Affiliated Hospital of Wenzhou Medical University from September 2014 to October 2015.Serum GM test was performed for all , and BALF GM test for a proportion of the patients .The patients were divided into an IPA group and a non-IPA group. SPSS 20.0 was adopted for statistical analysis.Results A total of 1361 cases were enrolled, aging 18-96 years, with an average age of (64 ± 15) years.There were 879 male and 477 female patients.Thirty-nine cases were diagnosed as IPA , accounting for 2.9%.For serum GM test, the sensitivity, specificity, PPV and NPV were 43.6%(17/39), 94.1%(1239/1317),17.9%(17/95)and 98.3%(1239/1261)respectively.Ninety-six cases received serum and BALF GM tests at the same time.If the cut-off value of BALF GM test was 0.8, the sensitivity, specificity, PPV and NPV were 86.7%(13/15),60.5%(49/81),28.9%(13/45),96.1%(49/51) respectively, but if the value was 1.0, the sensitivity, specificity, PPV and NPV were 86.7%(13/15),74.1%(60/81),38.2%(13/34), 96.8%(60/62)respectively.The ROC curve area of BALF GM, serum GM and the combined serum and BALF GM was 0.87, 0.75 and 0.90, respectively.Conclusions The sensitivity of serum GM test in non-neutropenic hosts was low , but it had a high negative predictive value . The best BALF GM cut-off value was 1.0.The combined serum and BALF GM tests improved the diagnostic performance.