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

Early diagnostic value of bronchoalveolar lavage for pulmonary aspergillosis in non-immunocompromised patients

摘要:

目的 探讨支气管肺泡灌洗液（BALF）对免疫功能正常患者肺曲霉病的早期诊断价值，并了解 支气管肺泡灌洗术操作方法对半乳甘露聚糖（GM）试验的影响，初步探讨建立统一的检测肺泡灌洗液GM 试验的支气管肺泡灌洗术及取样操作方法与流程。方法 对2016 年1 月-2017 年2 月因肺部感染在该院呼 吸内科诊治的患者84 例，进行BALF 收集。按照收集灌洗液顺序前后收集2 管送检GM 实验，根据结果病例 组及对照组内均分为GM1 及GM2 亚组。根据诊断标准及分级制度，将患者分为病例组22 例（包括确诊2 例、 临床诊断7 例、拟诊13 例）以及对照组62 例。统计并分析病例组和对照组的GM 试验结果。结果 GM1 与GM2 组检测的GM-I 值有明显差异，且GM1 的I 值平均秩较高（Z =-3.98，P =0.000）。BALF-GM1 界 限值0.60，诊断效率最高。敏感度86.36%，特异度93.55%，阳性预测值82.61%，阴性预测值95.08%。BALFGM1 的曲线下面积（0.941）明显高于BALF-GM2（0.798）。结论 支气管肺泡灌洗术中收集BALF 的操作 顺序对BALF-GM 试验I 值大小存在影响，送检第1 管肺泡灌洗液BALF-GM 试验对肺曲霉病诊断具有更高 的应用价值。

Abstract:

Objective To investigate the early diagnostic value of bronchoalveolar lavage for pulmonary aspergillosis in non-immunocompromised patients. The GM absorbances of recycled bronchoalveolar lavage fluid in different orders were compared, in order to estabilsh a uniform of broncholaveolar lavage in GM test. Methods We mainly focused on the patients (84 cases) confirmed as pulmonary infection by HRCT chest imageological examination from January 2016 to February 2017. They underwent the bronchoalveolar lavage before empirical or pathogenic antifungal therapy. Meanwhile, the lavage was collected in order of the first and the second tube. Then, BALF-GM test was performed. The GM absorbance (A) and I value of bronchoalveolar lavage fluid were detected by ELISA method. The GM test result of the first tube of bronchoalveolar lavage fluid was included into GM1 group and the GM test result of the second tube of bronchoalveolar lavage fluid was included into GM2 group. According to the standards, the patients were divided into case group (proven 2 cases, probable 7 cases, possible 13 cases) and non-IPA group (62 cases). The GM test diagnostic efficiency of bronchoalveolar lavage fluid collected in differentorders were statistically analyzed between the case group and control group. Results The GM-I values showed significant difference between GM1 and GM2 groups (Z = -3.98, P = 0.000). the average rank I value of BALFGM1 (1.78 ± 1.71) was significantly higher than the BALF-GM2. According to the ROC curve, the optimal cutoff of BALF-GM1 was 0.6, the sensitivity was 86.36%, the specificity was 93.55%, the positive predictive value was 82.61% and the negative predictive value was 95.08%. The area under the curve of BALF- GM1 (0.941) was significantly higher than that of BALF-GM2 (0.798), indicating that the diagnostic efficiency of BALF-GM1 was higher. Conclusion The operation sequence of collecting bronchoalveolar lavage could affect the I value of BALFGM test. The diagnostic efficiency of BALF-GM test result of the first tube of bronchoalveolar lavage fluid was higher and had the higher application value in the diagnosis of pulmonary aspergillosis.