The Diagnostic Efficacy of Alveolar Lavage Fluid G test and GM Test in AECOPD Complicated with Invasive Pulmonary Fungal Infection
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摘要:
目的 评价肺泡灌洗液1，3-β-D葡聚糖检测（G试验）和半乳甘露聚糖检测（GM试验）对慢性阻塞性肺疾病急性加重期（AECOPD）患者并发侵袭性肺真菌感染（IPFI）的早期诊断价值。 方法 随机选取2018年10月至2019年10月昆明医科大学第二附属医院急诊重症医学科收治的AECOPD存在肺真菌感染的患者26例，作为观察组，另选取同期收治的AECOPD仅存在细菌感染的患者26例，作为对照组，对两组患者血清及BALF测定G和GM试验水平进行统计分析，并对BALF测定G、GM试验的诊断价值进行统计分析。 结果 观察组中，BALF G试验阳性结果22例，GM试验阳性结果18例，血清G试验阳性结果20例，GM试验阳性结果16例，BALF GM联合G试验阳性23例；血清GM联合G试验阳性22例。BALF G试验联合GM试验检测特异性、灵敏度、阳性预测值、阴性预测值、假阳性率和假阴性率分别为92.3%、88.5%、93.5%、93.2%、7.7%和11.5%，P < 0.05。 结论 肺泡灌洗液G和GM试验对早期诊断AECOPD患者并发侵袭性肺真菌感染的临床价值高，且优于血清G和GM试验。 -
关键词:
- 肺泡灌洗液 /
- G试验 /
- GM试验 /
- 慢性阻塞性肺疾病急性加重期 /
- 侵袭性肺真菌
Abstract:Objective To evaluate the diagnostic efficacy of alveolar lavage fluid（1, 3）-beta-D-glucan（G）test and galactomannan（GM）test in early diagnosis of acute exacerbations of chronic obstructive pulmonary disease（AECOPD）complicated with invasive pulmonary fungal infection（IPFI）. Methods A total of 26 AECOPD patients with pulmonary fungal infection admitted to the Department of Emergency and Intensive Care Medicine, the Second Affiliated Hospital of Kunming Medical University from October 2018 to October 2019 were randomly selected as the experimental group, and another 26 AECOPD patients admitted in the same period only with bacterial infection were selected as the control group. The serum and BALF G and GM test results of the two groups, as well as the diagnostic efficacy of G and GM tests were analyzed. Results In the observation group, 22 cases were alveolar lavage fluid G test positive, 18 cases were GM test positive; 20 cases were serum G test positive, 16 cases were serum GM test positive; 23 cases were positive for G combined with GM test in alveolar lavage fluid, and 22 cases were positive for serum G combined GM test. The sensitivity, specificity, positive predictive value, negative predictive value, false positive rate and false negative rate of alveolar lavage fluid G test combined with GM test were 88.5%、92.3%、93.5%、93.2%、7.7%和11.5%, respectively, P < 0.05. Conclusion G and GM test in alveolar lavage fluid has a high diagnostic efficacy in the early diagnosis of AECOPD complicated with invasive pulmonary fungal infection, with G and GM test in alveolar lavage fluid better than G and GM test in serum. -
表 1 不同标本G、GM试验检测阳性率比较 [n （%）]
Table 1. Comparison of G and GM test positive rate between different specimens[n （%）]
组别 G试验 GM试验 BALF Blood BALF Blood 观察组（n = 26） 22（84.623） 20（76.871） 18（69.213） 16（61.521） 对照组（n = 26） 6（23.132） 7（26.872） 3（11.532） 4（15.412） χ2 21.672 15.061 19.742 13.587 P < 0.001 < 0.001 < 0.001 < 0.001 
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表 2 不同标本G、GM试验检测值比较（
$\bar x \pm s $ ）Table 2. Comparison of G and GM test result between different specimens（
$\bar x \pm s $ ）组别 G试验 GM试验 BALF Blood BALF Blood 观察组（n = 26） 37.512 ± 18.362 26.213 ± 12.579 1.862 ± 1.692 0.852 ± 0.687 对照组（n = 26） 14.803 ± 13.213 12.873 ± 7.731 0.221 ± 0.232 0.372 ± 0.253 t 4.253 5.423 4.314 4.262 P < 0.001 < 0.001 < 0.001 < 0.001
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表 3 不同标本G、GM试验单项及联合检测结果（%）
Table 3. G test，GM test or G combined with GM test result between different specimens（%）
检测项目 G试验 GM试验 G+GM试验 BALF Blood BALF Blood BALF Blood 特异度 76.9 73.1 88.5 84.6 92.3 88.5 灵敏度 84.6 77.9 69.2 61.5 88.5 84.6 阳性预测值 74.8 74.1 84.2 79.1 93.5 89.6 阴性预测值 82.3 75.6 74.5 69.2 93.2 87.3 假阳性率 23.1 26.9 11.5 15.4 7.7 11.5 假阴性率 15.4 23.1 30.8 38.5 11.5 15.4
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