半乳甘露聚糖在支气管扩张症合并肺曲霉菌病中的诊断价值

doi:10.3969/j.issn.1004-583X.2022.09.006

摘要/Abstract

摘要：

目的探讨血清和支气管肺泡灌洗液(BALF)中半乳甘露聚糖(GM)对支气管扩张症合并肺曲霉菌病的诊断价值。方法选取2018年3月-2021年3月东营市胜利油田中心医院呼吸与危重症医学科住院的支气管扩张症患者128例。根据诊断标准,将患者分为观察组41例(其中包括确诊病例12例,临床诊断病例29例),对照组82例。抗曲霉菌药物治疗前分别检测两组血清GM和BALF-GM,绘制两组受试者工作特征(ROC)曲线,比较两种检测方法在诊断支气管扩张症合并肺曲霉菌病中的诊断价值,使用ROC曲线确定血清和BALF-GM的截断值。结果血清GM和BALF-GM最佳截断值分别为0.65 μg/L (ROC曲线下面积AUROC 0.856,敏感度65.4%,特异度88.5%),和0.93 μg/L(AUROC 0.929; 敏感度80.4%,特异度95.0%)。当截断值为1.50 μg/L时,血清GM诊断支气管扩张症合并肺曲霉菌病的敏感度为11.5%,特异度为100%。在截断值2.0 μg/L时,BALF-GM诊断支气管扩张症合并肺曲霉菌病的敏感度和特异度分别为19.2%和100%。结论 BALF-GM在诊断支气管扩张症合并肺曲霉菌敏感度和特异度均优于血清GM,BALF-GM检测,可以协助诊断支气管扩张症合并肺曲霉菌。

关键词: 支气管扩张症, 肺曲霉菌病, 半乳甘露聚糖, 支气管肺泡灌洗液, 诊断

Abstract:

Objective To compare the efficacy of galactomannan (GM) in serum and bronchoalveolar lavage fluid (BALF) in the diagnose of the comorbidity of bronchiectasis and pulmonary aspergillosis (PA). Methods Totally 128 bronchiectasis patient from the Department of Respiratory and Critical Care Medicine, Shengli Oilfield Central Hospital (March 2018- March 2021) were enrolled into observation group (n=41, including 12 diagnosed cases and 29 clinically diagnosed cases) and control group (n=82) as the diagnostic result. The serum GM and BALF-GM were respectively conducted to detect in two groups before instituting anti-Aspergillus therapy, the receiver operating characteristic (ROC) curves were drawn to compare the diagnostic value of the two detection on the comorbidity of bronchiectasis with PA and assess the cut-off values of serum GM and BALF-GM. Results The Optimal cut-off values of were 0.65 μg/L for serum GM (area under the ROC curve [AUROC] of 0.856; sensitivity of 65.4%; specificity of 88.5%) and 0.93 μg/L for BALF-GM (AUROC of 0.929; sensitivity of 80.4%; specificity of 95.0%). At a cut-off value of 1.5μg/L, the specificity and sensitivity in serum-GM were 11.5% and 100%, respectively; but at a cut-off value of 2.0 μg/L, those in BALF-GM were 19.2% and 100%, respectively. Conclusion BALF-GM is superior to serum GM for the sensitivity and specificity in the diagnose of the the comorbidity of bronchiectasis and PA, preferring to assist the diagnosis as a tool.

Key words: bronchiectasis, pulmonary aspergillosis, galactomannan, bronchoalveolar lavage fluid, diagnosis

中图分类号:

周景坤, 杨彩虹, 冯涛, 崔华英. 半乳甘露聚糖在支气管扩张症合并肺曲霉菌病中的诊断价值[J]. 临床荟萃, 2022, 37(9): 799-803.

Zhou Jingkun, Yang Caihong, Feng Tao, Cui Huaying. Diagnostic value of galactomannan on the comorbidity of bronchiectasis and pulmonary aspergillosis[J]. Clinical Focus, 2022, 37(9): 799-803.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.09.006

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I9/799

图/表 4

参考文献 19

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项目	观察组 (n=41)	对照组 (n=82)	统计值	P值
年龄(岁)	43.9(14.7)	47.8(16.5)	Z=1.28	0.203
性别(男)	21(51.2)	52(63.4)	χ²=1.357	0.102
体重指数(kg/m²)	20.8±4.6	21.5±4.2	t=10.844	0.400
住院时间(天)	9.55±4.20	8.95±3.10	t=0.8957	0.372
症状持续时间(年)	12.3±5.4	5.2±4.8	t=7.415	<0.01
咳嗽[例(%)]	35(86.5)	52(63.4)	χ²=2.912	0.157
咯血[例(%)]	30(73.2)	2(24.4)	χ²=25.510	<0.01
发热[例(%)]	14(34.5)	0
呼吸困难[例(%)]	15(35.6)	15(18.1)	χ²=0.933	2.078
mMRCⅠ[例(%)]	9(21.4)	14(17.1)	χ²=1.283	0.370
mMRCⅡ[例(%)]	4(10.1)	0
mMRCⅢ[例(%)]	2(3.8)	0
肺部湿罗音[例(%)]	35(85.4)	38(46.7)	χ²=4.293	1.390
肺部哮鸣音[例(%)]	18(43.5)	30(36.7)	χ²=0.384	1.903
肺功能
FEV1%pred(%)	53.57±11.05	56.26±12.57	t=5.488	0.0145
FEV1/FVC(%)	62.4±16.5	71.2±17.4	t=2.689	0.0812
白细胞计数(10⁹/L)	7.15±2.68	6.82±2.45	t=0.682	0.4963
PCT(μg/L )	2.18±0.76	2.26±0.82	t=0.522	0.6024
血红蛋白(g/L)	126.5±16.15	131.56±15.78	t=0.052	0.9587
血小板计数(10⁹/L)	260.56±77.71	255.78±73.05	t=0.036	0.9717
总蛋白(g/L)	69.22±7.54	72.43±7.27	t=1.280	0.244
白蛋白(g/L)	39.73±6.45	41.25±6.60	t=3.607	0.063

项目	观察组 (n=41)	对照组 (n=82)	统计值	P值
年龄(岁)	43.9(14.7)	47.8(16.5)	Z=1.28	0.203
性别(男)	21(51.2)	52(63.4)	χ²=1.357	0.102
体重指数(kg/m²)	20.8±4.6	21.5±4.2	t=10.844	0.400
住院时间(天)	9.55±4.20	8.95±3.10	t=0.8957	0.372
症状持续时间(年)	12.3±5.4	5.2±4.8	t=7.415	<0.01
咳嗽[例(%)]	35(86.5)	52(63.4)	χ²=2.912	0.157
咯血[例(%)]	30(73.2)	2(24.4)	χ²=25.510	<0.01
发热[例(%)]	14(34.5)	0
呼吸困难[例(%)]	15(35.6)	15(18.1)	χ²=0.933	2.078
mMRCⅠ[例(%)]	9(21.4)	14(17.1)	χ²=1.283	0.370
mMRCⅡ[例(%)]	4(10.1)	0
mMRCⅢ[例(%)]	2(3.8)	0
肺部湿罗音[例(%)]	35(85.4)	38(46.7)	χ²=4.293	1.390
肺部哮鸣音[例(%)]	18(43.5)	30(36.7)	χ²=0.384	1.903
肺功能
FEV1%pred(%)	53.57±11.05	56.26±12.57	t=5.488	0.0145
FEV1/FVC(%)	62.4±16.5	71.2±17.4	t=2.689	0.0812
白细胞计数(10⁹/L)	7.15±2.68	6.82±2.45	t=0.682	0.4963
PCT(μg/L )	2.18±0.76	2.26±0.82	t=0.522	0.6024
血红蛋白(g/L)	126.5±16.15	131.56±15.78	t=0.052	0.9587
血小板计数(10⁹/L)	260.56±77.71	255.78±73.05	t=0.036	0.9717
总蛋白(g/L)	69.22±7.54	72.43±7.27	t=1.280	0.244
白蛋白(g/L)	39.73±6.45	41.25±6.60	t=3.607	0.063

项目	观察组 (n=41)	对照组 (n=82)	统计值	P值
免疫学检查
曲霉菌IgG抗体(AU/ml)	146.5±12.5	50.25±12.2	t=40.910	<0.01
痰真菌培养	4(11.9)	0
来自烟曲霉	3(8.3)	0
来自黄曲霉	1(3.6)	0
BALF真菌培养
来自烟曲霉	9(21.4)	0
来自黄曲霉	4(10.7)	0
HRCT胸部表现
空洞数量	1.5±0.5	0.2±0.3	t=17.980	<0.01
新月体征	23(56.3)	0
斑块状浸润影	21(51.2)	8(9.8)	χ²=1.046	<0.01
随机结节	12(30.4)	28(34.2)	χ²=0.382	0.703
纤维化	28(67.5)	62(75.8)	χ²=0.834	0.406

项目	观察组 (n=41)	对照组 (n=82)	统计值	P值
免疫学检查
曲霉菌IgG抗体(AU/ml)	146.5±12.5	50.25±12.2	t=40.910	<0.01
痰真菌培养	4(11.9)	0
来自烟曲霉	3(8.3)	0
来自黄曲霉	1(3.6)	0
BALF真菌培养
来自烟曲霉	9(21.4)	0
来自黄曲霉	4(10.7)	0
HRCT胸部表现
空洞数量	1.5±0.5	0.2±0.3	t=17.980	<0.01
新月体征	23(56.3)	0
斑块状浸润影	21(51.2)	8(9.8)	χ²=1.046	<0.01
随机结节	12(30.4)	28(34.2)	χ²=0.382	0.703
纤维化	28(67.5)	62(75.8)	χ²=0.834	0.406

截断值	敏感度(%)	特异度(%)	Youden指数
血清GM
>0.5	69.2	84.6	0.538
>0.65^*	65.4	88.5	0.615
>1.0	46.2	92.3	0.426
>1.5	11.5	100.0	0.115
BALF-GM
>0.5	96.2	59.9	0.560
>0.93^*	80.4	95.0	0.754
>1.0	69.2	95.6	0.668
>1.5	50	99.7	0.530
>2.0	19.2	100.0	0.192