肺泡灌洗液半乳甘露聚糖、血液烟曲霉IgG联合检测对肺曲霉病的诊断价值研究

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目的:探究肺泡灌洗液半乳甘露聚糖(Gm)、血液烟曲霉IgG联合检测对肺曲霉病的诊断价值。方法:选取2017年2月至2019年9月浙江省海盐县人民医院收治的肺曲霉病患者74例,按照病理类型分为慢性肺曲霉病组35例及侵袭性肺曲霉病组39例。采集两组研究对象肺泡灌洗液,对肺泡灌洗液Gm水平进行检测,使用曲霉IgG酶联免疫吸附试验(ELISA)试剂盒检测血液烟曲霉IgG水平,对单独检测肺泡灌洗液Gm、血液烟曲霉IgG及二者联合检测的阳性预测率、阴性预测率、诊断灵敏度、特异度和准确性进行统计对比。结果:侵袭性肺曲霉病组肺泡灌洗液Gm I值、血液烟曲霉IgG水平均低于慢性肺曲霉病组[0.65 ± 0.09比0.98 ± 0.12、(118.95 ± 12.31)kAU/L比(147.63 ± 15.32)kAU/L],差异有统计学意义(n P<0.05)。联合检测肺泡灌洗液Gm I值、血液烟曲霉IgG水平对肺曲霉病进行诊断,阳性预测率、阴性预测率分别显著高于单独检测肺泡灌洗液Gm I值和血液烟曲霉IgG水平诊断[92.50%(37/40)比61.90%(26/42)和61.54%(24/39)、88.24%(30/34)比53.13%(17/32)和51.43%(18/35)],差异均有统计学意义(n P<0.05)。肺泡灌洗液Gm I值、血液烟曲霉IgG水平与肺曲霉病严重程度具有一定相关性。联合检测肺泡灌洗液Gm I值、血液烟曲霉IgG水平对肺曲霉病进行诊断,诊断灵敏度、准确率均高于单独检测肺泡灌洗液Gm I值、血液烟曲霉IgG水平[92.86%(39/42)比65.00%(26/40)和67.57%(25/37)、83.78%(62/74)比75.68%(56/74)和75.68%(56/74)],诊断特异度低于单独检测肺泡灌洗液Gm I值、血液烟曲霉IgG水平[71.88%(23/32)比88.24%(30/34)和83.78%(31/37)],差异均有统计学意义(n P<0.05)。n 结论:肺泡灌洗液Gm及血液烟曲霉IgG与肺曲霉病症状具有一定相关性,肺泡灌洗液Gm、血液烟曲霉IgG联合检测对肺曲霉病的临床诊断和治疗具有重要意义。“,”Objective:To explore the diagnostic value of the combined detection of galactomannan (Gm) in bronchoalveolar lavage fluid (BALF) and IgG of aspergillus fumigatus in blood for pulmonary aspergillosis.Methods:Seventy-four patients with pulmonary aspergillosis admitted to Haiyan People′s Hospital from February 2017 to September 2019 were divided into chronic pulmonary aspergillosis group (35 cases) and invasive pulmonary aspergillosis group (39 cases). The BALF of ttwo groups were collected, the Gm level of BALF was tested, and the IgG level of blood aspergillus fumigatus was detected by using the aspergillus IgG enzyme-linked immunosorbent assay (ELISA) kit, and the positive prediction rate, negative prediction rate, diagnostic sensitivity, specificity and accuracy of the two methods was compared.Results:The Gm I value of BALF and the IgG level of blood in invasive pulmonary aspergillosis group were lower than those in chronic pulmonary aspergillosis group: 0.65 ± 0.09 vs. 0.98 ± 0.12, (118.95 ± 12.31) kAU/L vs. (147.63 ± 15.32) kAU/L, and there were significant differences (n P<0.05). The positive predictive rate and negative predictive rate in combined detection of detection of GMI and IgG in BALF and blood were significantly higher than those in the single detection of GMI and IgG in BLAF and blood: 92.50%(37/40) vs. 61.90%(26/42) and 61.54%(24/39), 88.24%(30/34) vs. 53.13%(17/32) and 51.43%(18/35), and there were significant differences (n P<0.05). There was a certain correlation between the severity of pulmonary aspergillosis and the Gm I value of BALF and the IgG level of blood aspergillus fumigatus. The sensitivity and accuracy of the diagnosis in combined detection of Gm I and IgG in BALF and blood were higher than those in the single detection of Gm I and IgG in BALF and blood: 92.86%(39/42) vs. 65.00%(26/40) and 67.57%(25/37), 83.78%(62/74) vs. 75.68%(56/74) and 75.68%(56/74), the diagnostic specificity was lower than that of the single detection of GM I and IgG in BALF and blood: 71.88%(23/32) vs. 88.24%(30/34) and 83.78%(31/37), and there were significant differences (n P<0.05).n Conclusions:There is a certain correlation between Gm in BALF and aspergillus fumigatus IgG in blood and the symptoms of pulmonary aspergillosis. The combined detection of Gm in BALF and aspergillus fumigatus IgG in blood is of great significance for the clinical diagnosis and treatment of pulmonary aspergillosis.
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