Diagnostic value of galactomannan on the comorbidity of bronchiectasis and pulmonary aspergillosis

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

Abstract

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

CLC Number:

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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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.09.006

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

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References 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