支气管肺泡灌洗液半乳甘露聚糖检测在老年肺部疾病并存侵袭性肺曲霉病的诊断价值初探

目的 了解支气管肺泡灌洗液(BALF)半乳甘露聚糖(GM)检测在老年人肺部疾病并存侵袭性肺曲霉病(IPA)诊断中的价值。 方法 收集半年来因肺部疾病住院并高度怀疑并存IPA的老年患者，予支气管镜行支气管肺泡灌洗后，行BALF GM检测，同时行血清GM检测，并予痰或BALF真菌培养及涂片、胸部计算机断层显像(CT)等检查，依照欧洲癌症研究及治疗组织和真菌研究小组(EORTC/MSG)的建议，依宿主因素、临床特征、微生物学证据和组织病理学检查，将入选者分为确诊IPA、临床诊断IPA、拟诊IPA和非IPA患者，用统计学方法了解BAIF GM检测的诊断效率。 结果 共76例高度怀疑IPA的老年患者入选，其中1例确诊IPA，11例临床诊断IPA，6例拟诊IPA，以上18例作为病例组，其余58例非IPA患者作为对照组。当以GM值为0.5作为界值时，BALF GM检测的敏感度、特异度、阳性预测值及阴性预测值分别为83.3％、82.8％、60.0％和94.1％.而血清GM检测在同样界值时的敏感度、特异度、阳性预测值及阴性预测值分别为55.6％、91.4％、66.7％和86.9％；以GM值为1.0作为界值时,BALF GM和血清GM的特异度、阳性预测值均可达100％，但BALF GM检测的敏感度和阴性预测值（66.7％和90.6％）明显高于血清GM检测（22.2％和80.6％）。受试者工作特性曲线(ROC)分析结果显示，以GM值0.725为界值时BALFGM检测诊断效率最高，其敏感度、特异度分别为83.3％、96.6％。 结论 BAIF GM检测在诊断老年人肺部疾病并存IPA中具有重要意义，值得广泛推广。

The value of galactomannan detection in bronchoalveolar lavage fluid in the diagnosis of invasive pulmonary aspergillosis in elderly patients with lung diseases

Objective To evaluate the role of galactomannan (GM) detection in bronchoalveolar lavage fluid (BALF) in the diagnosis of invasive pulmonary aspergillosis (IPA) in elderly patients with lung diseases.Methods The elderly patients with lung diseases and suspected of having IPA were enrolled. BALF for culture and GM detection, and serum samples for GM detection were obtained from all participants. According to European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) with host factors, clinical criteria, mycological evidence and histological or cytopathological evidence, all patients were categorized into the proven, probable,possible and no IPA patients. The IPA patients were considered as IPA group while no IPA was considered as control group. Results Among 76 enrolled elderly patients, 18 cases were diagnosed with IPA (1 proven, 11 probable and 6 possible), the remained 58 patients were as control group.Based on a GM index cutoff value of ≥0. 5, the sensitivity, specificity, positive predictive value and negative predictive value for BALF were 83.3％, 82. 8％, 60.0％ and 94.1％, respectively; these variables in serum were 55.60％ , 91.4 ％, 66.7 ％ and 86.9％ , respectively. Using a GM index cutoff value of ≥1.0, the specificity and positive predictive value of both BALF GM and serum GM reached 100％, but the sensitivity and negative predictive value of BALF GM were higher than serum GM (66.7％ vs. 22.2％, 90.60％ vs. 80.60％, respectively). Receiver operating characteristic curve analysis yielded a sensitivity of 83.4％ and a specificity of 96.6％ at a BALF GM index cutoff value of ≥0.725. Conclusions GM detection in BALF seems to be a useful tool in the diagnosis of IPA in elderly patients with lung diseases,and could be widely used in future.