内参标化的肺泡灌洗液GM试验对侵袭性肺曲霉菌病诊断效能的探讨

中国真菌学杂志　 2019, Vol. 14 　Issue (5): 280-283.

内参标化的肺泡灌洗液GM试验对侵袭性肺曲霉菌病诊断效能的探讨

邱菊, 黄琳, 陈嵌, 夏吉荣

重庆医科大学附属第一医院检验科, 重庆 400010

收稿日期:2019-04-20 出版日期:2019-10-28 发布日期:2019-10-28
通讯作者: 夏吉荣,E-mail:xjr196352@163.com E-mail:xjr196352@163.com
作者简介:邱菊,女(汉族),在读研究生.E-mail:jane_juqiu@163.com

Exploration of bronchoalveolar lavage fluid GM test standardized by internal reference in the diagnosis of invasive pulmonary aspergillosis

QIU Ju, CHEN Qian, HUANG Lin, XIA Ji-rong

The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010

Received:2019-04-20 Online:2019-10-28 Published:2019-10-28

摘要/Abstract

摘要：

目的探讨肺泡灌洗液（BALF）半乳甘露聚糖检测（GM试验）内标物质的选择及内标化的方法，以及内标化后的BALF GM试验是否能够提高对侵袭性肺曲霉病（IPA）的临床诊断效能。方法收集2018年5月至2019年1月重庆医科大学附属第一医院临床拟诊为IPA住院患者的BALF标本156例，同时对曲霉菌抗原、钾离子（K⁺）、尿素（UREA）、白蛋白（ALB）进行检测，依据组织病理、微生物结果、临床症状及特征、宿主因素等资料将研究对象分为IPA组39例和非IPA组117例，统计分析标化校正和未标化校正的BALF GM试验结果对IPA临床诊断效能的影响。结果标化校正和未标化校正的BALF GM试验I值在两组间均存在显著性差异（P<0.001），经ROC曲线分析显示非标化BALF GM试验I值的cut-off值为0.69时，曲线下面积为0.731（P<0.001），灵敏度71.8%，特异度70.1%；用K⁺、UREA、ALB标化BALF GM试验I值后的ROC曲线分析，各cut-off值分别为0.605、1.905、0.69，曲线下面积分别为0.71、0.653、0.701（P值分别为<0.001、0.004、0.002），灵敏度分别为74.4%、66.7%、69.2%，特异度分别为70.9%、63.2%、69.8%。结论非标化BALF GM试验I值cut-off值为0.69时对IPA的诊断效能最高；用K⁺标化后的BALF GM试验I值诊断IPA的效能优于非标化的BALF GM试验结果（P<0.001）。

关键词: 侵袭性肺曲霉菌病, GM试验, 肺泡灌洗液, cut-off值, 内参

Abstract:

Objective To to choose and standardizeinternal reference of bronchoalveolar lavage fluid galactomannan detection(BALF GM test), and to investigatewhether the BALF GM test after standardizing could improve the clinical diagnostic efficiency for invasive pulmonary aspergillosis(IPA). Methods A total of 156 BALF specimens were collected from The First Affiliated Hospital of Chongqing Medical University from May 2018 to January 2019. All samples were performed GM test and the levels of potassium, urea and albumin were measured. According to histopathology, microbiological results, clinical symptoms and characteristics, host factors and other data, all patients were divided into two groups:IPA group(39 cases) and non-IPA group(117 cases).The clinical diagnostic efficiencies of standardized and non-standardized BALF GM tests for IPAwere compared. Results The I values of the standardized and non-standardized BALF GM tests were both significantly different between two groups(P<0.001).The ROC curves showed that the cut-off value of the non-standardized BALF GM test was 0.69, the area under the curve was 0.731(P<0.001), the sensitivity was 71.8%, and the specificity was 70.1%. After standardizing by K⁺, UREA, and ALB, the cut-off values were 0.605, 1.905, 0.69, and the areas under the curve were 0.71, 0.653,0.701, respectively(P<0.001, 0.004, 0.002, respectively).The sensitivities were 74.4%, 66.7%, 69.2%,and the specificities were 70.9%, 63.2%, 69.8%, respectively. Conclusion With the cut-off value of 0.69,the non-standardized BALF GM test hadthe best diagnostic efficiency for IPA. The diagnostic efficiency of the BALF GM test after standardizing by K⁺ for IPA wasbetter than the non-standardized BALF GM test(P<0.001).

Key words: invasive pulmonary aspergillosis, GM test, bronchoalveolar lavage fluid, cut-off value, internal reference

中图分类号:

R519.8

邱菊, 黄琳, 陈嵌, 夏吉荣. 内参标化的肺泡灌洗液GM试验对侵袭性肺曲霉菌病诊断效能的探讨[J]. 中国真菌学杂志, 2019, 14(5): 280-283.

QIU Ju, CHEN Qian, HUANG Lin, XIA Ji-rong. Exploration of bronchoalveolar lavage fluid GM test standardized by internal reference in the diagnosis of invasive pulmonary aspergillosis[J]. Chinese Journal of Mycology, 2019, 14(5): 280-283.

参考文献

[1] He H, Ding L, Li F, et al. Clinical features of invasive bronchial-pulmonary aspergillosis in critically ill patients with chronic obstructive respiratory diseases:a prospective study[J]. Critical care (London, England), 2011, 15(1):R5.
[2] 中华医学会呼吸病学分会感染学组,中华结核和呼吸杂志编辑委员会.肺真菌病诊断和治疗专家共识[J].中华结核和呼吸杂志,2007,30(11):821-834.
[3] 中华医学会呼吸病学分会.肺部感染性疾病支气管肺泡灌洗病原体检测中国专家共识(2017年版)[J].中华结核和呼吸杂志,2017,40(8):578-583.
[4] 徐媛,陈敏,廖万清.中国侵袭性曲霉菌病流行病学现状[J].中国真菌学杂志,2018,13(1):57-60.
[5] Wohlfarth P, Turki AT, Steinmann J, et al. Microbiologic diagnostic workup of acute respiratory failure with pulmonary infiltrates after allogeneic hematopoietic stem cell transplantation:findings in the era of molecular-and biomarker-based assays[J].Biol Blood Marrow TR,2018,24(8):1707-1714.
[6] Anne-Pauline B, Houssein GH, Natacha T, et al. Local retrospective analysis of galactomannan cut-off values in bronchoalveolar lavage fluids for diagnosis of invasive aspergillosis[J]. Folia Microbiologica, 2018,63(6):757-761.
[7] Hoenigl M, Prattes J, Spiess B, et al. Performance of galactomannan, beta-d-glucan,Aspergillus lateral-flow device, conventional culture, and PCR tests with bronchoalveolar lavage fluid for diagnosis of invasive pulmonary aspergillosis[J].J Clin Microbiol,2014, 52(6):2039-2045.
[8] Lahmer T, Rasch S, Schnappauf C, et al. Comparison of serum galactomannan and 1,3-Beta-D-Glucan determination for early detection of invasive pulmonary aspergillosis in critically ill patients with hematological malignancies and septic shock[J]. Mycopathologia, 2016, 181(7):1-7.
[9] He H, Ding L, Sun B, et al. Role of galactomannan determinations in bronchoalveolar lavage fluid samples from critically ill patients with chronic obstructive pulmonary disease for the diagnosis of invasive pulmonary aspergillosis:a prospective study[J].Crit Care. 2012 Jul 27;16(4):R138.
[10] Mingxiang Z, Lanhua T, Shushan Z, et al. Correction:systematic review and meta-analysis of detecting galactomannan in bronchoalveolar lavage fluid for diagnosing invasive aspergillosis[J]. PLOS ONE,2017,12(12):e190459.
[11] 林其昌, 林晓, 陈公平, 等. 支气管肺泡灌洗液肿瘤标志物联合检测诊断肺癌的研究[J]. 中国内镜杂志, 1999,5(4):3-5.
[12] 唐安珏,宋卫东,徐平.支气管肺泡灌洗液对免疫功能正常肺曲霉病患者的早期诊断价值[J].中国内镜杂志,2017,23(11):24-29.