摘要
目的 研究支气管肺泡灌洗液(BALF)(1,3)β-D葡聚糖检测(G试验)、半乳甘露聚糖检测(GM试验)对侵袭性肺部真菌感染(IPFI)的早期诊断价值.方法 前瞻性的收集2017年1月至2018年3月安徽医科大学第二附属医院重症医学科内具有IPFI高危因素的患者资料共95例.根据《肺真菌病诊断与治疗专家共识》将所有患者分为IPFI组43例,非IPFI组52例.并根据是否为曲霉菌感染,将患者分为侵袭性肺曲霉菌病(IPA)组和非IPA组.所有患者均进行血清和BALF G和GM试验.分析各组间BALF G、GM试验结果的差异,并与血清G、GM试验结果比较,通过绘制受试者工作特征曲线(ROC)分析上述指标的诊断价值.结果 ①IPFI组和非IPFI组BALF G试验结果分别为(294.07±137.78)ng/L、(94.74±46.21)ng/L,差异有统计学意义(P =0.000);IPFI组和非IPFI组血清G试验结果分别为(25.26±12.17)ng/L、(15.02 ±6.05)ng/L,差异有统计学意义(P=0.036);IPA组和非IPA组BALF GM试验结果分别为2.68 ±1.98、0.53 ±0.40,差异有统计学意义(P=0.001);IPA组和非IPA组血清GM试验结果分别为0.63±0.21、0.25 ±0.17,差异有统计学意义(P=0.030).BALF G试验用于早期诊断IPFI的ROC曲线下面积(AUC)为0.900(P<0.001),95%置信区间(CI)为0.841 ~0.960,最佳诊断阈值为157ng/L,此时Youden指数、敏感度和特异度分别为0.64、81.2%和83.1%;而血清G试验用于早期诊断IPFI的ROC曲线ACU为0.556(P=0.35),最佳诊断阈值22 ng/L,其Youden指数、敏感度和特异度分别为0.11、37.2%和73.1%.BALF GM试验用于早期诊断IPA的ROC曲线AUC为0.99(P =0.001),95% CI为0.936 ~1.000,最佳阈值为1.08,此时Youden指数、敏感度和特异度分别为0.918、99%和92.8%;而血清GM试验用于早期诊断IPA的ROC曲线AUC为0.732(P=0.025),95% CI为0.590 ~0.875,以0.5为诊断阈值时,Youden指数、敏感度和特异度分别为0.443、88.9%和55.7%.结论 BLAF G试验、GM试验对于诊断IPFI、IPA的敏感度、特异度明显优于血清,有利于IPFI、IPA的早期诊治.BALF G试验用于预测IPFI的阈值为157 ng/L,BALFGM试验用于预测IPA的阈值为1.08.
Objective To study the value of bronchoalalveolar lavage fluid ( BALF) G test and GM test in the early diagnosis of invasive pulmonary fungal infection (IPFI). Methods A total of 95 patients with IPFI risk factors in the intensive care department of the Second Hospital of Anhui Medical University from January 2017 to March 2018 were prospectively collected. According to expert consensus on diagnosis and treatment of pulmonary mycosis, all patients were divided into IPFI group (43 cases) and non - IPFI group (52 cases). Patients were divided into invasive pulmonary aspergillosis (IPA) and non - IPA group according to whether they had aspergillosis. Serum, BALF G and GM tests were performed in all patients. The differences in BALF G and GM test results between the groups were analyzed and compared with the results of serum G and GM test. The diagnostic value of the above indicators was analyzed by drawing the ROC curve. Results ①BALF G test results of the IPFI group and the non - IPFI group were ( 294. 07 土 137. 78 ) ng/L and (94. 74 ± 46. 21 ) ng/L, respectively, with statistically significant differences ( P = 0. 000). The results of serum G test in IPFI group and non - IPFI group were ( 25. 26 ± 12. 17 ) ng/L and ( 15. 02 ± 6. 05 ) ng/L, respectively, with statistically significant difference (P =0. 036). BALF GM test results of IPA group and non - IPA group were (2. 68 ± 1.98 ) and (0. 53 ± 0. 40), respectively, and the difference was statistically significant (P = 0. 001 ). The results of serum GM test in IPA group and non - IPA group were (0. 63 ±0. 21) and (0. 25 ±0. 17), respectively, and the difference was statistically significant ( P = 0. 030).②The area under the ROC curve of BALF G test for early diagnosis of IPFI was 0. 900 ( P < 0. 001 ), the 95% confidence interval was 0. 841 -0. 960, the optimal diagnostic threshold was 157 ng/L, and the Youden index, sensitivity and specificity were 0. 64, 81. 2% and 83. 1%, respectively. The area under the curve of serum G test for early diagnosis IPFI was 0. 556 ( P = 0. 35), the optimal diagnostic threshold was 22 ng/L, and its Youden index, sensitivity and specificity were 0. 11, 37. 2% and 73. 1%, respectively.③The area under the curve of BALF GM test for early diagnosis of IPA was 0. 99 ( P < 0. 001 ), the 95% confidence interval was 0. 936 一 1. 000, and the optimal threshold was 1. 08. The Youden index, sensitivity and specificity were 0. 918 , 99. 0% and 92. 8%, respectively. The area under the curve of serum GM test for early diagnosis of IPA was 0. 732 (P =0. 025), and the 95% confidence interval was 0. 590 -0. 875. When 0. 5 was the diagnostic threshold, the Youden index, sensitivity and specificity were 0. 443 , 88. 9% and 55. 7%, respectively. Conclusion The sensitivity and specificity of BLAF G test and GM test for the diagnosis of IPFI and IPA are significantly better than serum, which is conducive to the early diagnosis and treatment of IPFI and IPA. The threshold of BALF G test for IPFI prediction is 157 ng/L, and the threshold of BALF GMtest for IPA prediction is 1.08.
作者
方余
张频捷
杨翔
曹利军
孙昀
赵卉
Fang Yu;Zhang Pin-jie;Yang Xiang;Cao Li-jun;Sun Yun;Zhao Hui(Department of Intensive Care Unit, the Second Hospital of Anhui Medical University, Hefei 230601, China)
出处
《中国急救医学》
CAS
CSCD
北大核心
2019年第9期827-831,共5页
Chinese Journal of Critical Care Medicine
基金
国家自然科学基金面上项目(81670060).
