支气管肺泡灌洗液半乳甘露聚糖诊断老年肺曲霉病的研究

BALF-GM in the Diagnosis of Elderly Pulmonary Aspergillosis

中文关键词: 支气管肺泡灌洗液  半乳甘露聚糖  抗体  诊断

英文关键词: bronchoalveolar lavage fluid  galactomannan  antibody  diagnosis

中文摘要:

      目的 比较支气管肺泡灌洗液半乳甘露聚糖(BALF-GM)、血清GM、血清烟曲霉IgG、IgM抗体对老年非粒缺宿主侵袭性肺曲霉感染的早期诊断价值.方法 采用ELISA法检测37例临床考虑为侵袭性肺曲霉感染老年非粒缺患者BALF-GM、血清GM和13例患者血清曲霉抗体水平.结果 BALF-GM的灵敏度、特异度、阴性预测值高于血清GM,阳性预测值低于血清GM,曲霉感染患者BALF-GM值高于其血清GM值(P＜0.05)和细菌性感染患者BALF-GM值(P＜0.05).BALF-GM适宜折点为0.61.血清烟曲霉IgG检测敏感性、特异性、阳性预测值和阴性预测值分别为71.42％、66.67％、71.42％和66.67％,血清烟曲霉IgM分别为75.00％、44.44％、37.50％和80.00％.结论 BALF-GM、血清烟曲霉特异性IgG抗体对老年非粒缺宿主侵袭性肺曲霉感染患者的临床诊断有重要意义,其诊断价值高于血清GM和烟曲霉特异性IgM抗体.

英文摘要:

      Objective To compare the values of bronchoalveolar lavage fluid Aspergillus galactomannan antigen (BALF-GM),serum GM,aspergillus fumigatus serum IgG,IgM antibody in the early diagnosis of invasive pulmonary aspergillosis (IPA) in the elderly non-neutropenic patients.Methods The levels of BALF-GM,serum GM,serum IgG and IgM of the patients clinically suspected to be with IPA infection were detected by enzyme-linked reaction adsorption test (ELISA).Result The sensitivity,specificity and negative predictive value of BALF-GM were higher while the positive predictive value was lower than those of serum GM;the level of BALF-GM in patients with aspergillus infection was significantly higher than that of serum GM (P ＜ 0.05) and higher than the level of BALF-GM in patients with bacterial infection (P ＜ 0.05);the optimal BALF GM cutoff value was 0.61;the sensitivity,specificity,positive predictive value and negative predictive value of serum Aspergillus fumigatusantibody IgG was 71.42％,66.67％,71.42％ and66.67％ respectively while those of IgM was 75.00％,44.44％,37.50％ and 80.00％ respectively.Conclusion BALF-GM and serum IgG are of great significance in the diagnosis of IPA in the elderly non-neutropenic patients,and their diagnostic values are superior to those of serum GM and IgM.