支气管肺泡灌洗液G试验和GM试验对侵袭性曲霉菌感染的早期诊断价值

摘要

目的：探讨支气管肺泡灌洗液（ BALF ） G试验和GM试验对侵袭性曲霉菌感染的早期诊断价值。方法检测32例侵袭性肺部曲霉菌感染患者和24例肺部细菌性感染患者的BALF的GM抗原和BG抗原水平。计算G试验和GM试验的灵敏度、特异度、阳性预测值和阴性预测值。使用ROC曲线比较G试验和GM试验的诊断价值，用kappa值来说明G试验和GM试验诊断的一致性。结果 G试验的灵敏度、特异度、阳性预测值和阴性预测值分别为84.38％、83.33％、87.10％和80.00％，曲霉菌感染患者BALF的BG浓度明显高于细菌性感染患者（ P＜0.05）。 GM试验的灵敏度、特异度、阳性预测值和阴性预测值分别为81.25％、87.50％、89.66％和77.78％，曲霉菌感染患者BALF的I值明显高于细菌性感染患者（ P＜0.05）。 G试验和GM试验ROC曲线下面积分别为0.839和0.844， kappa 值为0.57，一致性较好，差异无统计学意义（ P＞0.05）。 G试验的灵敏度略高于GM试验，而GM试验的特异度则高于G试验，差异均无统计学意义（ P＞0.05）。结论 BALF G试验和GM试验对侵袭性曲霉菌的早期临床诊断有重要意义，诊断结果具有较好的一致性。%Objective To investigate the value of galactomannan antigen assay and 1, 3 beta-D-glucan assay in bronchoalveolar lavage fluid ( BALF) in the early diagnosis for invasive aspergillosis .Methods A total of 32 pa-tients with invasive aspergillosis and 24 patients with bacterial infections were performed G test and GM test and the levels of BG antigen and GM antigen were measured .The sensitivity, specificity, positive predictive values and nega-tive predictive value were calculated .The ROC curve was used to compare the diagnostic values of G test and GM test, with kappa values to illustrate the consistency of G test and GM test .Results The sensitivity, specificity, posi-tive predictive values and negative predictive value were 84.38%, 83.33%, 87.10%and 80.00%respectively in G test , and 81.25%, 87.50%, 89.66%and 77.78%respectively in GM test .The levels of BG antigen and GM anti-gen in patients with invasive aspergillosis were significantly higher than those in patients with bacterial infection ( P<0.05 ) .The areas under the ROC curve were respectively 0.839 and 0.844 in G test and GM test , with kappa value 0.57 ( P>0.05 ) .The sensitivity of G test was slightly higher than that of GM test , while the specificity of the G test was slightly lower than that of GM test , without a significant difference ( P>0.05 ) .Conclusion BALF G test and GM test is very important for early diagnosis of invasive aspergillosis .