BALF-GM联合曲霉IgG及IgM抗体对慢性肺曲霉病的诊断价值

目的 探讨肺泡灌洗液半乳甘露聚糖（BALF-GM）联合曲霉IgG、IgM抗体检测在慢性肺曲霉病（CPA）中的诊断价值。方法 将确诊为CPA的88例患者作为研究组,疑似CPA经确诊后排除的64例患者作为对照组。回顾性分析所有患者的BALF-GM、曲霉IgG及IgM抗体水平,采用受试者工作特征（ROC）曲线分析各检测方法BALF-GM、曲霉IgG、IgM及其联合检测对CPA的诊断价值。结果 BALF-GM诊断CPA价值较高,曲霉IgG、IgM等指标及其联合检测的诊断价值较低,BALF-GM联合曲霉IgG/IgM检测灵敏度有明显提高,但特异度下降。研究组BALF-GM、曲霉IgG、IgM含量均高于对照组,2组比较差异均有统计学意义（P均< 0.05）;2组BALF-GM、曲霉IgG、IgM及联合检测阳性率比较差异均有统计学意义（P均< 0.05）。ROC曲线分析显示BALF-GM诊断CPA、BALF-GM+曲霉IgG/IgM联合诊断CPA的曲线下面积均较高,灵敏度、特异度高,曲霉IgG、IgM及IgG/IgM联合检测的诊断价值均较低。结论 BALF-GM诊断CPA具有较高的灵敏度和特异度;BALF-GM联合曲霉IgG/IgM检测可提高其诊断灵敏度,但特异度会显著降低,因此需结合BALF-GM单独检测的高特异度来尽量降低假阴性的发生。

Diagnostic value of BALF-GM combined with Aspergillus IgG and IgM in chronic pulmonary aspergillosis

Objective To investigate the diagnostic value of bronchoalveolar lavage fluid-galactomannan （BALF-GM） in alveolar lavage fluid combined with Aspergillus IgG and IgM in chronic pulmonary aspergillosis （CPA）. Methods 88 patients with CPA were assigned into the study group, and 64 patients suspected with CPA who were excluded after diagnosis were divided into the control group. The levels of BALF-GM, Aspergillus IgG and IgM in all patients were analyzed retrospectively. The diagnostic value of BALF-GM, Aspergillus IgG, IgM and combined detection in CPA was analyzed by the receiver operating characteristic （ROC） curve. Results The diagnostic value of BALF-GM in CPA was higher, whereas that of Aspergillus IgG, IgM and combined detection was lower. The sensitivity of BALF-GM combined with Aspergillus IgG/IgM was significantly improved, but the specificity was decreased. The contents of BALF-GM, Aspergillus IgG and IgM in the study group were significantly higher than those in the control group （all P < 0.05）. The positive rates of BALF-GM, Aspergillus IgG, IgM and combined detection significantly differed between two groups （all P <0.05）. ROC curve analysis indicated that BALF-GM, BALF-GM+Aspergillus IgG/IgM yielded higher area under ROC curve （AUC）, sensitivity and specificity in the diagnosis of CPA. The diagnostic value of Aspergillus IgG, IgM and IgG/IgM combined detection was lower. Conclusions BALF-GM has high sensitivity and specificity in the diagnosis of CPA. BALF-GM combined with Aspergillus IgG/IgM can improve the diagnostic sensitivity, whereas significantly decrease the specificity. Therefore, it is necessary to integrate the high specificity of BALF-GM alone to minimize the incidence of false negative results.